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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS . <br /> N O» <br /> 715- M <br /> OWNER Wd6-'V TELEPHONEa1Ua 3y34 <br /> 1 Y <br /> MAILING ADDRESS <br /> r � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) / C v a, r ;,5 . C`q C—,vt/ <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 In o <br /> TYPE OF PERMIT(S): C Q SCJ <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ �LJ a <br /> STRUCTURE/ADDITION USE: ar i'3 r'1- 0 <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) cn <br /> m r`\ <br /> BUILDING CONTRACTOR: <br /> 1 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Ya X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> .'V fNiIlll CC, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <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. I r* <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <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 <br /> 0 <br /> CONDITIONS OF PERMIT: <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> _ / <br /> 5. SETBACK AREA.�- J-P S � �3 ! <br /> 6. V <br /> —/no <br /> JS/1�n /�/U !i�–LC J /Lll.� ✓'^N� `'C 3 'acel F a <br /> 7. Z v, CD <br /> o T� ;U <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cC <br /> C: <br /> and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m n v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize _ \ CD o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- M .v <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 G ' <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 premise r the purpose of inspection. `D s <br /> T <br /> 0 : <br /> 22 CD N E <br /> SIGN HERE 2, <br /> q n : <br /> '(signature of ow r bu <br /> 2 <br /> ilding contract ) UUL (date) <br /> L L <br /> ZONING ADMINISTRATOR <br /> � �� UUN 1 O(T cNnNO <br /> TOWNSHIP PERMITS MA iN O <br />