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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> N � <br /> y <br /> C <br /> OWNER,,"M/ <br /> TELEPHONE <br /> MAILING ADDRESS �Q ��,../.m re <br /> sC O <br /> PROPERTYADDRESS 'e��s-fes �!� . / C19 D <br /> lS'us 3,s— <br /> // r <br /> LEGAL DESCRIPTION(see tax receipt) �O�Ne r � <br /> T o <br /> m <br /> a <br /> DWELLINGIBUIL01 G GARAGEIACCESSORY STRUCTURE ❑ ADDITION Co 'p' <br /> TYPE OF PERMIT(S): � � <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: CD n-S <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. AN INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL ORTOP VIEW) // <br /> �Eirev S G!� -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. —' n o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE a <br /> NORTH(N). <br /> M m <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 -o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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 BEGRADED OR FILLED. N <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. <br /> o <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. g / <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CIZ <br /> CONDITIONS OF PERMIT: ° <br /> t G-. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> W y � O n <br /> 6. pE m <br /> CD <br /> Bnm � a � A <br /> ° m : � m <br /> I declare that this application (including any accompanying schedule) has been exam ned by me and to the best of m - o) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am <br /> responsible for the detail and accuracy of w n C <br /> all informati n ntained in this application(including any accompanying schedule)an J I further declare that I recognize m m <br /> that this inf mati n I am providing will be relied upon by the County of Burnett Wisco isin in determining whether to is- m cn <br /> sue a permit. fu a ccept all liability which may be a result of the County i am m : o <br /> providing int a I ation. I agree to permit county officials charg with i I m <br /> authorized pers t ac ss to the above described premises at ny reas <br /> CL : <br /> CL : <br /> SIGN HERE m D <br /> JUL 1 va a <br /> ign a of owner 'ding contractor) o <br /> ZONING ADMINISTRATOR <br /> A <br /> NTY <br /> ZONING URNETT 47roo cn�^ N <br /> N W W N O <br /> TOWNSHIP PERMITS <br /> �MAY BE REQUIRED I,, ZONI � � <br /> THIS PER��j-m( EXPIRE <br /> )e- -kr I1� D� FISSUANCEIeCi') I4rd &+0 <br />