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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> r <br /> N <br /> OWNER L A �V,R TELEPHONE -i ' <br /> MAILINGADDRESS V �/'� , O <br /> oil s#da _ <br /> PROPERTY ADDRESS 16 02- W t 54 g o I✓' <br /> LEGAL DESCRIPTION(see tax receipt) 1l <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE JR ADDITION ❑ <br /> O <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> < <br /> (� \ <br /> STRUCTURE/ADDITIONOSE: PO u. o p ,` <br /> 1 \ (Home/Cabin;,Cpomme ial Business; Bedroom; Deck; etc.) N <br /> VV <br /> BUILDING CONTRACTOR: Q 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. :3 <br /> O (� <br /> A n <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) p C) <br /> T a <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m <br /> NORTH(N). c _, <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 13 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I Z <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. <br /> 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. 2. o <br /> F <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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 /> TBACK AREA. ( p y,� p <br /> 5. /S/1¢!l rY11 L✓L11W^u I ? hl <br /> C � a mW'm0oaov <br /> 3 n m �0 a m A <br /> 9 p N C N N 0 5 3 <br /> Z C H O 10 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �9A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m ; m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is J <br /> O : <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials chAwith Tnt <br /> authorized person to ve access to the above described premises i t e i '^ 0 i <br /> D <br /> SIGN HERnat re of owns r ilding contractor) J AN (dat9o <br /> ' o <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING {Jo a o u u v o <br /> THIS PERMIT SHALL EX IR OrE YEVR FROM DAT 0F S UA <br />-- ra�� e�- T r❑cc ( c{ �r� Ccrylc�,' I-asU, <br />