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Burnett County 7410 Co.Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - G I Z <br /> APPLICATION FOR LAND USE PERMITS / { 3 (V <br /> OWNER TELLEEPHONE <br /> MAILINGADDRESS 3dL yZ V, Dmf/ I✓,/,.N[J(,R �.•/�.si� kr 5V,,70 2 ? <br /> PROPERTYADURESS <br /> LEGAL DESCRIPTION(sec lax receipt) Lor 13 LSN) -,A l0/S I", 6??gf' PP"�76- r f' <br /> DWELLINGIBUILDING N GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑L�"'-cA `a" Srcd. ( m c <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ - <br /> STRUCTURE/ADDITION USE <br /> (Hor elCabm Commercial Business: Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: vi/w"^�L�T✓J"�Z "'sj m J <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ONATILEASTAN 8%X 11 SHEET OF PAPER. ANYINCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. F m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH IN). y 1 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m /� a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF W z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND GRAINFIELD(DF),AND ALL DISTANCES TO w <br /> BUILDINGS,ROADS, LAKE, LOT LINES. (]p £ a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS a �. y <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> o Y <br /> NOTE: NGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. - <br /> NEEDED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: t <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT b <br /> ISSUANCE. IW <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <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. <br /> 5. <br /> p mOr DODO pLp <br /> 6. m x3iim a�. 3 <br /> v c c N <br /> 0to <br /> 0 <br /> m <br /> declare that this application including any accompanying schedule) has been examined me and to the best 2 . : C <br /> knowledge and ballet it is[rue,, correct and complete. acknowledge that I am responsible foror the detail and accuracy <br /> 1 y of n <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize J m $ : En <br /> A M <br /> that this Information I am providing will be relied upon by the County of Burnell Wisconsin in determining whether to is. m m <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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or oth. v <br /> - <br /> aulhorized person to ve a rasa to a ova described premises at any reasonable time for the purpose of inspection. <br /> > <br /> SIGN HERE <br /> -x-06 V <br /> re�of owner or building contractor) Ia <br /> nota( ate) & — <br /> ZONING ADMINISTRATOR r 1 o n ` <br /> C ouo�uuo <br /> TOWNSHIP PERMITS MAY BE REQUIRED C <br /> S PERMIT SHAFL EXPIRE ONE Y€AR FROM ,ATE OF ISSUANC <br /> L'orr)ers�O�Q- �jnS�t"uC�rdh r1-7 bd <br />