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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION_,_FQO�Ru �L/A' 'N`D USE PERMITS 3 <br /> N ,O . <br /> L /�P 0. RAX �7 � � T 0 <br /> 9a— <br /> owNER -( � wyBr^IlTELEPHONE'71 S --�L� <br /> MAILINGADDRESS - C) 1 1 5 - (2L - 4`I J <br /> r m <br /> PROPERTYADDRESS r <br /> LEGAL DESCRIPTION(see tax receipt)L I a -1 g 17 SII (1 e do vi �¢, 4-r� � <br /> ICD <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ ARAG GE/ACCESSORY STRUCTURE ADDITION ❑ o' <br /> FILLING/GRADING 1:1 CfMPING UT SUBDIVISION E G&J- Q � <br /> © ❑ � QJ <br /> STRUCTURE/ADDITIONUSE: 0 mo�a <br /> � <br /> (Home/ bin; Commercial Business;Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <br /> v ^. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 J <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> O <br /> Tl H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a �t <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> �b 4 <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 N�' I ` <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),AND ALL DISTANCES TO <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. S <br /> v 0 <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. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 /> AREA. <br /> 5. <br /> SETBACK <br /> CD � y 0 � > <br /> 6. 8 3 am xa� z <br /> 7 'O N C y N 0 3 <br /> Z ^ m o <br /> G rm <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my //�� � - y A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W m C v. C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD ; 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 Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other W <br /> authorized person to haye access to the above described premises at any reasonable time for the pur ose of inspection. m <br /> -n 0 : <br /> CD <br /> CD <br /> SIGN HERE cin (' L <br /> (signs ur 'o er or building cont ct r) (d e) �' 1 <br /> ZONING ADMINISTRATOR / <br /> fA fA fN iN <br /> N U N <br /> N 0 O O <br /> O(TOCT (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />