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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o � <br /> -U o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> y O <br /> N <br /> OWNER 'led ea 4Gv TELEPHONE/16-1 ;? D <br /> MAILING ADDRESS 3g' � ` � �� J/�/ '�,` J� M <br /> PROPERTYADDRESSd� <br /> 77 <br /> LEGAL DESCRIPTION(see tax receipt) M <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ O <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a �' <br /> _ y <br /> STRUCTURE/ADDITION USE: C�' 1 o <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: J m <br /> N <br /> 'U <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> I PLOT PLAN DO <br /> . T <br /> /� — N <br /> LDIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ) O a <br /> --- In Z V <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. F) m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (0 3 <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. •J v' o l R <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO y� <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS ^ 0.(Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. \ I <br /> v <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. ZE <br /> CONDITIONS OF PERMIT: p U1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r� <br /> ISSUANCE. b ` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. (0j/ S ' ' 1 <br /> v,\ Mo WryN <br /> 0 <br /> 6. m3am x <br /> CN : O <br /> 7. O <br /> O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of @ v, <br /> CL v 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c : o : mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 oO <br /> providing in this application. I a ee to permit county officials charged with administering county ordinances or other <br /> authorized person to have cces o the above described premises at any reasonable time for the purpose of inspection. m s <br /> -n o : <br /> �f n7 /l ry N <br /> SIGN HERE 7'a3-61 "' <br /> gnature of owner or buildi contractor) (date) <br /> o. <br /> ZONING ADMINISTRATOR <br /> N Cin N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />