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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 /> r <br /> UT O <br /> C <br /> _tt `� pp q q fD QU <br /> OWNER 6 2G °� ( t AR�1 ' R OMP S 0 ry TELEPHONE r L J t) a 4'0 1 1 7 v <br /> m <br /> ` Q A(� y�1 C <br /> MAILING ADDRESS Z4 3 a L—, A/ YMti ��' �\ O S EV 1 LL-� 1,\'V J 1 (-3 O <br /> V r o <br /> m <br /> PROPERTY ADDRESS( P Q L. E Jb �— b �- F� (� N fz: 0'1` D` <br /> LEGAL DESCRIPTION(see tax receipt) <br /> » <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING CAMPI G UNIT SUBDIVISION n <br /> STRUCTUREIADDITION USE: a �� X� 0 <br /> (Hom abin; Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> m <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 /> O <br /> r11 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 71 0 fi <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). fCA U(\` 03 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> v <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS Q/ <br /> MUST BE SIGNED AND DATED BY THE OWNER. r o <br /> I o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN5t 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i <br /> CONDITIONS OF PERMIT: (_� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <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 ({, V•fl <br /> PERMITTED. �I <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> tt k1 <br /> 6. $ CD <br /> 0 0 q=5 N <br /> Z N O O <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n » <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mO mm <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. I agree to permit county officials charged with administering county ordinances or other ` N <br /> authorized person to have access to the above described premises at any re sonable time for the purpose of inspection. - o <br /> SIGN HER D ' 8' L5 3 o <br /> (signaf owner or building ntractorI (date) <br /> ZONING ADMIN,STRAT R CU 1 <br /> di fA N <br /> N C) N O <br /> U O N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED NJ <br />