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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator _U 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N O <br /> OWNER P40 L SE�-7 ,/` TELEPHONE 6-497— Ag g—*3 n U <br /> MAILING ADDRESS je �� v F <br /> PROPERTY ADDRESS � $'4cj dtfk 7� 42' ��/P� <br /> r7�f <br /> LEGAL DESCRIPTION(see tax receipt) .( <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o <br /> TYPE OF PERMIT(S): � � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> T /y—� 0 <br /> STRUCTUREIADDITION USE: o <br /> L{dome/Cabin;xommerclaTBusiness; Bedroom;Deck;etc.) <br /> M ; <br /> BUILDING CONTRACTOR: <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. In 3 3 <br /> O v <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> In o <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). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. C <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 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. I o <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ON VERIFI J TION (Jfl o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J 8 Oct S? o O <br /> CONDITIONS OF PERMIT: <br /> Ln <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITOrCOUA` L W <br /> ISSUANCE. 'Y n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NTNG ' 7 <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. OleJFm Wari0MOaov <br /> 3 n m x a <br /> ED C y o 3 <br /> 7. Z info : �� =1 <br /> P n` <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <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 G <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other w <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. nn <br /> mCD <br /> rn <br /> SIGN HERE �� !/<- �G'Z4-41Z v, <br /> a : <br /> (signature of owne r building contractor) 17 (date) <br /> ZONING ADMINISTRATOR � /!Yl <br /> /, fAMfM fA� N <br /> �1 (n OCn IT 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED C <br />