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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> N � <br /> N <br /> C <br /> D <br /> OWNER I� (J �� TELEPHONE 9-2o <br /> 00 <br /> n �l mzo <br /> MAILINGADDRESS P 0_ zVx ( q Souk eelL, 1- AA, <br /> PROPERTYADDRESS <br /> y [� <br /> LEGAL DESCRIPTION(see tax receipt) S'GG �� — 3 G( —1 ��Ark) o' $ <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n y <br /> TYPE OF PERMIT(S): n y, Q c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB VI)SION F n 1 v19 a <br /> STRUCTURE/ADDITIONUSE: <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) rn = (� <br /> BUILDING CONTRACTOR: �eI' St.(,/V �u �Af krGrc4C 7� <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a Z <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). � o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. M <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o F <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 <br /> ISSUANCE. C) <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 /> X w WD 0 0 n F m <br /> 6. �' 3 a m Oc a f;a <br /> -6 m CN o 3 <br /> �3 <br /> 7. Z in fo : 1 <br /> o i 41Q : iA <br /> M <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my W cj C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d o vi <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize <br /> CD o rn <br /> nom : cn :, mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° cn <br /> m o : <br /> CD m <br /> SIGN HERE <br /> n : <br /> ig ature of n or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> l+6A EA ffl fA�N <br /> („N(TNNOO <br /> UtO(TNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />