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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator _U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> Vi <br /> t^n� IOtTELOWNER r� CJPHONE d(0 <br /> n <br /> 0MAILINGADDRESS <br /> r � <br /> f 0 <br /> PROPERTYADDRESS See- 2nclgSP����q+IAij <br /> 3 6- <br /> �y i' (� T c 1,� ( 1 <br /> LEGAL DESCRIPTION(see tax receipt) L o4— X IOC h I � 1 c7y �r I QS V S�('t� m <br /> ,r 1 <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE W ADDITION ❑ (` o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: 14 orvi a bt n �t o I� ��l I ��� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;e co nom\ <br /> BUILDING CONTRACTOR: 4S Vl ` x-76 <br /> d <br /> 4uadLd��w (D <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLE EOR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> IZI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). a --�'n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 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. �1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. J� N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS (� 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. n o <br /> o 0 �jNOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � 0 <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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 WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m d°r0oaov <br /> F m <br /> 2 9 21 O D C y N O <br /> 7. Z N NO O <br /> O T G <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — N ' A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n <n c <br /> CL cn W <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o . 0 <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. 1 agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m C <br /> o : <br /> SIGN HERE a'��1 <br /> (signature own e r building contractor) (date) Q) n <br /> ZONING ADMINISTRATOR 434 to <br /> 1-TOWNSHIP PERS A�REQUIRED I 1 <br /> Q�ytid- ��L <br />