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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator '0 o z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> H <br /> GWNER6,�r V Z �/7 r /5��� TELEPHONE //" ✓/ / r/�'�� 0 <br /> MAILING ADDRESS // <br /> o a 5 3u,�.�'v� <br /> / r � <br /> PROPERTYADDRESS Al (,fGl 'v � 1 0 <br /> s1;71-3cY / 7w 61 <br /> LEGAL DESCRIPTION(see tax receipt) 41 /Q 1�1( Yoe <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n o <br /> TYPE OF PERMIT(S): ,�,( v <br /> FILLING/G DING ❑ CAMPING UNIT/f��l SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 0 <br /> (Ho a/Cabin;Commercial usiness;Bedroom;Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> � ✓1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 00 o <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. f7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d <br /> BUILDINGS, ROADS, LAKE, LOT LINES. O <br /> 5. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. = F P <br /> o YJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: R <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Jv <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 [THIN THE REQUIRED WATER <br /> 5. SETBACK AREA. <br /> Cll x / m m 0 M a g m <br /> 6. �� �' �` L� D' CD w <br /> a ,D as <br /> p y N O s- <br /> 7. @' <br /> 7. y, O 0 <br /> o -n�- <br /> cn : T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- li � <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 county officials charged with administering county ordinances or other o <br /> authorized person to ha cs to the above de cri premises at any reasonable time for the purpo of i pection. ° o <br /> CD <br /> SIGN HERE �n�' Z�— 4 4 <br /> n <br /> ( ' nature of owner ui[d ontra o Q ZONING ADMINISTRZOR v <br /> EA fA + N <br /> N 0 N N O O <br /> TOWNSHIP P RMITS MAY BE REQUIRED <br /> I `<,(d-S r1C NO T TOO <br />