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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> rn O <br /> CD <br /> f/1 <br /> C <br /> OWNER /p .J OL.�//, /� ( TELEPHONE10 AZJ�� p <br /> MAILINGADDRESS ��ga <br /> PROPERTYADDRESS <br /> / r 1 <br /> LEGAL DESCRIPTION(see tax receipt) A0` - V .�� P f17 rCD <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ( rn ° <br /> TYPE OF PERMIT(S): o. <br /> QQQ , Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONT. <br /> ❑ /" <br /> STRUCTURE/ADDITION USE: c'A& Pa'2-T <br /> :(Home/Cabin; Commercial Busiines��s;��Beedrroca;Deck;etc/.) <br /> &BUILDING CONTRACTOR: G/ � �T//gk'C./I� CJ <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEIAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> U N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o T <br /> T <br /> -n a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C —9NORTH 0 <br /> � n <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(SII MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c ° <br /> 4. SHOW THE LOCATION OF THE WELL(VIII), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS'OLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N"'V <br /> 6. IF SEPARATE PLANS ARE SUBMITTED AY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS V <br /> MUST BE SIGNED AND DATED BY THE gWNER. ° <br /> o � <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. o <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Ci <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. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. / 1AA <br /> Q m w m 00 °D. � m <br /> 6. �. 3 Rm Ox nm <br /> O CD C <br /> Z M ry O <br /> = rn : A <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my QQ � C <br /> knowledge and belief it is true,correct and gomplete. I acknowledge that I am responsible for the detail and accuracy of W. a <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m 0 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 llility which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. 1 a to remit county officials charged with administering county ordinances or other o <br /> authorized person to hav acc to oNe described premises at any reasonable time for the purpose of inspection. m o <br /> m m : <br /> � m <br /> SIGN HERE CL <br /> (signature of owiher u Ing contractor) f / (date) <br /> ZONING ADMINISTRATOR w—�C u,v, <br /> n fA EA E E -+ N <br /> N A N N 0 0 <br /> O O T P 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />