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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 <br /> Office of APPLICATION FOR LAND USE PERMITS Hing Administrator ' o Z <br /> r <br /> y O <br /> OWNER TELEPHONE YG o I n <br /> MAILING ADDRESS ���� (/ / GCD <br /> PROPERTYADDRESS �- o CD <br /> LEGAL DESCRIPTION(see tax receipt) 1 C 1 <br /> ( - �X1V L � cn T <br /> DWELLING/BUILDING ❑ /ACCESSORY STRUCTURE ❑ CD <br /> »' <br /> TYPE OF PERMIT(S): GARAGEADDITION o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ v <br /> STRUCTURE/ADDITION USE: ke /H <br /> a <br /> (Home/Cabin, Commercial Business, Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: �t'{ m <br /> eu <br /> Z � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING O(AERIAL OR TOP VIEW) 0 y <br /> c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. CD <br /> CL <br /> 0 o <br /> NORTH(N). z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. a <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO z <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> CONTRACTOR, <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER, OR, ETC.,THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> / 1 <br /> � o W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: z <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( w <br /> ISSUANCE. (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> a) n r D D <br /> <D Al ID n 0 d <br /> 7. m 3nOD0, <D <br /> v - <br /> Z Na $ : 'tea <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my I T� D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracyof \ rn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m U, <br /> d � vi <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin rt determining whether to recognize <br /> 9 m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying to this information I ais-m t7 <br /> Providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to a ecce to the ab e d ibed premises at any reasonable time for the purpose of inspection. m m. <br /> i <br /> m <br /> SIGN HERE m o <br /> G m m i <br /> (signature of owner or ui / � Y L^6 7 � v <br /> g contractor) (date) n <br /> ZONING ADMINISTRATOR 1 / f(rrpp <br /> r�e) <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N o 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />