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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS _ ° <br /> r <br /> N � <br /> OWNER (D <br /> TELEPHONE �s 3 g/-53 IZ _v <br /> �v 0 <br /> MAILING ADDRESSS ST p <br /> / v <br /> (DJ <br /> /� n o <br /> PROPERTYADDRESS �,3-"Y - �'/7i J,�C�T <br /> LEGAL DESCRIPTION(see tax receipt) CJO u �T 17V l `j-IC/6-;jCD <br /> �^�r,[�J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE V� ADDITION ❑ o <br /> TYPE OF PERMIT(S): � � <br /> FILLING/GRADING ❑ CAMP NG UNIT El SUBDIVISION ❑! a <br /> -/I SL^I y� <br /> STRUCTURE/ADDITIONUSE QtYpg9 Iv�,Te t�,t�,o n V �/ <br /> o N �1 <br /> (Home/Cabin; Commercial usiness; a room; Deck;etc.) rn ' Il <br /> d d <br /> BUILDING CONTRACTOR: _#'Y\Vse <br /> I -' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ?J m <br /> O m <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T_ Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o A <br /> NORTH(N). <br /> m m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In o <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 `T O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE N <br /> PLANS ( � r <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o 0 <br /> NEEDED. <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o 7,6 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n\ <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 /> SETBACK AREA. <br /> 5. <br /> 6. com iu r0 a :E <br /> 3 am 01 nm M <br /> 7 a m Cy `^ o � 3 <br /> Z Hmo <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - o' : A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d o d, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C o m <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 liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit unty officials charged with administering county ordinances or other <br /> authorized perso o ave access to the above _3c <br /> cribed premises nt any reasonable time for the purpose of inspection. m Cn <br /> T 0 . <br /> (D o : <br />;IGN HERE m m <br /> l f 1 69 m <br /> (s atu of owe b 'ding contractor) ate) a <br />!ONING ADMINISTRATOR: <br /> P 1 <br /> fA V! 69�+N <br /> TOWNSHIP PERMITS MAY BE REQUIRED CNO ((1100 <br />