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Burnett County 7414 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) `Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> y 0 O <br /> v <br /> OWNER �; / �f�ss TELEPHONE lis -s b-AY7 0 <br /> /� CD <br /> MAILINGADDRESS 3 / �y9 At 15 �! LRA /�r� ��X �A/ n U/ Sy&- �� <br /> PROPERTYADDRESS3� 7 4 n411;N /Q� 1 <br /> 7✓ <br /> LEGAL DESCRIPTION(see tax receipt) / 4 A C r,/ Fyi�. n/ 'y6 a) Cn <br /> DWELLING/BUILDING ® /A <br /> GARAGECCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): Cy 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> U.1 a <br /> STRUCTURE/ADDITIONQSE: /7 D /I^ `0 <br /> o' 1 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) to <br /> BUILDING CONTRACTOR: Tin -oeod/E- Lvi ll 46:1-Z 13ut'ledrns <br /> d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M y <br /> O m <br /> T a <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(NB)AND INDICATE m O O A <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 m0 <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 STANCES TO Q <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED O N <br /> 6. SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT <br /> M T CLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. J/ 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI N MAYONE <br /> NEEDED. e� p� o _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �NO h C CLdIl� I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ��NG�tijy <br /> ISSUANCE. 11 I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. X\J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIREDWATER OCJ <br /> SETBACK AREA. <br /> 5. <br /> 6. m obiz01 *af rrn <br /> aA <br /> 2 3 xam A <br /> 7. a m y y y 0 <br /> Z i000 to 1 <br /> m <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 d n <n C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Co m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 oO <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection, m to <br /> -n = : <br /> CD o : <br /> CD m i <br /> SIGN HERE <br /> (signature of ow building contractor V : a <br /> (date) <br /> ZONING ADMINISTRATOR wG� <br /> / IV fA di EA fA N <br /> NNNNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED f (�(��( NON (T O 0 <br />