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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> rn o <br /> � S 1 <br /> OWNERITELEPHONE <br /> OMAILING ADDRESS7rC) ljetj-�b1 ihja pQ (o <br /> PROPERTYADDRESSX A �ao e L /; <br /> -Iced <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) � u, <br /> DWELLING/BUILDING ❑ GARAGE)ACCESSORY STRUCTURE ❑ ADDITION m o <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRAD� ` <br /> I\NG'qE�/lI� CAMPING UNIT ❑ SUBDIVISION ❑ a ,,' <br /> STRUCTURE/ADDITION USE: G/ l/K_ 0 +J <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: <br /> S � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. /I T 3 3 <br /> l/ O <br /> J <br /> i C A <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O n <br /> T <br /> 71 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 WO A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m `" <br /> NORTH(N). c O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)70 ALL LOT LINES, (B) BUILDING(S)TO m \ 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF C>Q 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 /> S. 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 0 r <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 <br /> o � I <br /> y O ` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. t., 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ` (W <br /> � <br /> CONDITIONS OF PERMIT: P T <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 r _ <br /> PERMITTED. lYnl <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> �7 to OBD OD O U <br /> m c m d n ,p o. F m <br /> 6. � � 3 0. � <br /> p N C y y O j 3 <br /> 7. Z C N ry O > tp <br /> O m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y 1 Y Y !7 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy C <br /> of m N <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize m ci m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m rn : 0 <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 o <br /> providing in this application. I 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. <br /> fJ/J /f '' � T a <br /> SIGN HERCO� Y�¢d�' fyy7-y / Q,s�s�6 D <br /> Y" m <br /> v+ n i <br /> (signature of ownely uildi�rg contractor) (date) O <br /> f�C�nCoiGtn , > <br /> ZONING ADMINISTRATOR (» <br /> O�fA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED $ U f1 o N o 0 <br /> THI$,PE�I�S�I��P��rNE_ ,YEAJtFR�OM D/A�E,��d <br />