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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator m 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> T —r� 1 ` <br /> OWNER �1D�YJ C✓C TELEPHONE <br /> r v <br /> MAILING ADDRESS egoS • QAltx Sex- <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) -3q,3 / a ��—Cr/(� O m <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION (n o <br /> TYPE OF PERMIT(S): i <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ° <br /> STRUCTURE/ADDITIONUSE: �2IYLOQ�M 1x a�� �O ` eZ VeZ 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) C/) <br /> BUILDING CONTRACTOR:,e.'t I,�S$ L S SN(� p. • �q� �. (o OSCJ�+XJC' '— " I <br /> iu <br /> v <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. -n 41� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> -n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �v 1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M <br /> NORTH(N). a <br /> 6=1 - <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)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. 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 BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS bo <br /> MUST BE SIGNED AND DATED BY THE OWNER, 2 F <br /> O J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN M. o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i <br /> CONDITIONS OF PERMIT: ^� <br /> n Jv <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 oci <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> ET K AR <br /> 6. r l� "�/• l� C�^Y 7'`T ^�J� //C� 1Y1 11J m� w Z ev a v <br /> B o-CD <br /> ctk-ti cru — no -recger frI y� uf�cl�, ID C= y o 3 <br /> �. Z Ngo : <br /> : 21 z <br /> 1 declare that this application(including any accompanying schedule) has been examined by me and to the best of my — ti A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ; 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 <br /> G) <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. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m ? <br /> m o : <br /> (D N <br /> SIGN HERE <br /> (signature ner or building coa tor) date) <br /> ZONING ADMINISTRATOR --J27 / <br /> (T CT O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED A.,0$Q 4L, <br />