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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APP LI ATIOFOR LAND USE PERMITS 3. <br /> r <br /> U o <br /> a <br /> OWNER �— TELEPHONE — 0 <br /> MAILING ADDRESS Oso <br /> r � <br /> 0 <br /> PROPERTY ADDRESS15� 9 72 <br /> / �r� 4-q0-1V <br /> /— <br /> LEGAL DESCRIPTION(see tax receipt) / LI C-Jm /` q D 1 V j <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION (n <br /> TYPE OF PERMIT(S): ) <br /> FILLING/GRADING ❑ C MPING UNIT SUBDIVISION <br /> a <br /> STRUCTURE/ADDITION USE: /A LWA <br /> ( me/C in; omm cial Busi ass; B dr m; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LE ST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AE RIAL OR TOP VIEW) O m <br /> n a <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 XISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m A <br /> NORTH (N). <br /> 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 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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. �0. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o c) <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 /> 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. _ C .� (� C�Y� <br /> 5. ��y/),1,Q� 9 – �' U �h' 074//Z ^ O l �j Q / <br /> CD Wd <br /> 6. 3 am sam <br /> a m C y 0 o <br /> 7. Z N (D ' tO <br /> o T� m <br /> m <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 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 1 recognize m o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 d <br /> providing in this application. agree to erm t county officials charged with administering county ordinances or other <br /> authorized person to have acce4 to the AbVve d scribed premises at any reasonable time for the purpose of inspection. ° o <br /> CD <br /> � m m <br /> SIGN HERE GO d' o <br /> na ure of owner o . g contractor) (date) C i <br /> ZONING ADMINISTRATOR <br /> lah <br /> di fA diM0 N <br /> N Ut N N O O <br /> (T O (T (T O O <br /> TOWNSH P P MITS MAY BE REQUIRED <br />