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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C) Z <br /> APPLICATION FOR LAND USE PERMITS _� o <br /> r <br /> N <br /> OWNER } TELEPHONE � , -t3 S2V'GYcn <br /> m (DQ <br /> MAILING ADDRESS '� (aCj Maa"e-k I c{2 1nC LU l S4 b'3 7 O <br /> PROPERTY ADDRESS Wl <br /> U, <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CD <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Sy ADDITION LJ v 0 <br /> � o � <br /> �c � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: )}Gt dti iej r -4o q ttvcL� Gt <br /> (HO e/Cabin; Commercial Business; Bedroom; Deck; etc.) ��_ <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O = <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O n <br /> -n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <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 C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS V� ° Q� <br /> MUST BE SIGNED AND DATED BY THE OWNER. -- 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 7 <br /> NEEDED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O y1) 1 <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. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. n coo / c , / _L/ <br /> 5. �!�✓� �� �'1 f�L��L G Vt�� 4D r J haA V 1 l C <br /> 6. —moi I �o � DOa � M <br /> m x 3 R m a m A <br /> omC� o � <br /> � $ <br /> 7. z Co ' ,a ,4 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of U m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- min 0 <br /> G) : � : <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to ave access to the above described premises at any o inspection. a <br /> T <br /> a <br /> N ` D i <br /> SIGN HERE na <br /> (signature of ownerbuilding contractor) ( at o <br /> ZONING ADMINISTRATORJ 2004 � . <br /> •' fli L <br /> TOWNSHIP PERMITS MAY BE REciMbIETT COUNTY o N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE(ZOM �idCE `'/ <br />