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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER _ TELEPHONE <br /> MAILINGADDRESS <br /> PROPERTYADDRESS PLi75S _ ltlSL 1 <br /> I Q <br /> LEGAL DESCRIPTION(see lax receipt) 1,!5 . _�_ � m <br /> /-- r.,/ __ __— •moi <br /> DW ELLINGIBUILDING ❑ GARAOEIACCESSORY STI-WUMRE 1:1 ADDITION Ff Q m <br /> TYPE OF PERMIT(S): <br /> FILLINGIGHADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURDADDITION USE: Jn=_f4-0,., (Hom/Ct1"v Ciomma iaIl(Tm❑ CL D�k; 1 <br /> d <br /> BUILDING CONTRACTOR <br /> m JJJ <br /> A PLOT PLAN MUST BE PROVIDED ON LEAST AN BY.X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> A x IS <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 n VJ <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS iEB)AND ALL NEW BUILDINGS(NS)AND INDICATE <br /> NORTH(N). C0�Vpo <br /> W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(5)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILOING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS L`1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. _ Y' <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 4 <br /> NEEDED. _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I n <br /> CONDITIONS OF PERMIT: (1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <) T4 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. "h <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `fes <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> A and = > 0n0 ,y�p <br /> 7. <br /> a o 1 <br /> Z A <br /> T m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my : : 'n <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracyof r`, u <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize E O <br /> that this information I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to ie- J m. <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. I agree to permit county officials charged with administering county ordinances or other <br /> I: I d <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ; <br /> m n: <br /> SIGN HERE 7— 7 — O p// <br /> (si'+m1t/.'ofe <br /> fo n or.bwou c/o�nt/aai,t-) (dato) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> p a 6 <br /> T ah)ake R+o GQ QF��m4ucn 7-a1 06 <br />