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ON COMPUTER/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> O <br /> / ,5 <br /> OWNER h TELEPHONE r rt7 C <br /> v <br /> MAILING ADDRESS g .l G1 itl _I O <br /> PROPERTY ADDRESS ifi� <br /> LEGAL DESCRIPTION(see tax receipt) TC-'S m�5 L� of S YY1 I <3 5el _S <br /> s / Z3 0 o C SryI �' - ' rn _ <br /> O <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ S� d 6- 3 0 ' <br /> TYPE OF PERMIT(S): ( � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ m L/ 7 I a <br /> < <br /> STRUCTURE/ADDITION USE: �� //J e /5-ko v O� <br /> 0 <br /> yy/ <br /> (Home/Cabin; Com/mesal Business;Bedroom; Deck;etc.) 'n� <br /> BUILDING CONTRACTOR: i//LI[/7lL !'c T�/PdO/� �i /� —/ �MP� /C e Q. <br /> v <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. \J 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) w <br /> O =m <br /> a <br /> T_1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(Nm m <br /> B)AND INDICATE v <br /> 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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 'R <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 1 - 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 PLANS N <br /> 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q <br /> o f <br /> 0 F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> Chi I <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 01 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY .� <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. QnS1Fe Ole- j,rd-(!- <br /> 6 <br /> �W > O D O -0 <br /> M E m <br /> m <br /> 3 n m x 2 M ;V7 ' O N W y y 0 -3 <br /> Z N M 0 _to i <br /> T� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I 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 2 o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D <br /> sue a permit. I further accept all liability which may be a result of the County of B r ram C <br /> providing in this application. I agree to permit county officials charged with ad g r ter d <br /> authorized person to have access to the above described premises at any reason' o o i til m <br /> m <br /> : 0 : <br /> CD <br /> SIGN HERE `D m <br /> C : <br /> (51' natu of owner or building contractor a <br /> ZONING ADMINISTRATORBUR1pl 1 NEGGI1h� <br /> fA EA vi fA .... N <br /> ZONING �cNnovN I'a moo <br /> TOWNSHIP PERMITS MAY BE REQUIRED - O <br /> p2rmt-4- 4- le4�Kr mc;led 40 Vir-�mj�t, Kl ,5-a3aS <br />