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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 3 <br /> r 31 <br /> fG <br /> OWNER TELEPHONE 0079 n <br /> '-e k <br /> nn "' / / 0 <br /> MAILING ADDRESS q6`7 / pQ o5pe C"r" Ave bfi4 b U e U LU h 5L� p&e <br /> O <br /> PROPERTYADDRESS 7�a q �l�'QJ/Ia�T <br /> 01I1RGE o'c St?IIoW <br /> LEGAL DESCRIPTION(see tax receipt) SeCTIoN ,qU /e /(fl (J L0 81IC <br /> 1 m <br /> 1:12 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION U,��-e (-�-- IY Q <br /> STRUCTURE/ADDITION USE: L/S f oQj <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) U) Q <br /> m <br /> BUILDING CONTRACTOR: <br /> iu <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. *1 3 <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a <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 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 qzzz 03 <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) AHD ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. �,�., <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE G 66p,C Qt.€D. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILD R, C ftACT0i2,°E�C THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. IS r o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE�(ERIFIC �NJNAY BEVONP`WHEN <br /> NEEDED. �j n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. V�� O`9) �j <br /> CONDITIONS OF PERMIT: 20 CO, ° <br /> Niti UN G; � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �K <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Do <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 /> mWrrDi a >0 -0 <br /> m <br /> 6. 2 3 'amOOELm ;u <br /> N N N O <br /> 7. O N '1� O A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bestof my — 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 it cou cials charged with administering county ordinances or other <br /> authorized person to have ac ss to a ve des ribed pre ises at any reasonable time for the purpose of inspection. <br /> C�j TI O <br /> N (D . <br /> SIGN H E l6 d Z vi <br /> ( <br /> a signatur�wner or uildin contractor) (date) � <br /> ZONING ADMINISTRATOR J <br /> K� u <br /> .N <br /> O Ut N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED f <br />