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Burnett Caunty 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator � o° 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> y W <br /> c _ <br /> yJ d <br /> OWNER TELEPHONE'2(S- b'bb -y <br /> O <br /> MAILING ADDRESS �C7 x <br /> r m <br /> PROPERTY ADDRESS GD p l;ed N „LcK 1.� �1 e 1�S 1^✓ W <br /> LEGAL DESCRIPTION(see tax receipt) <br /> (n O <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ c <br /> c <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADI G �C AI;G'UNIT ❑ SUBDIVI ION l J y <br /> J 77 (� <br /> 0 Jif <br /> STRUCTURE/ADDITION USE: to <br /> ;om 1 Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X i 1 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 33H <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING! (AERIAL OR TOP VIEW) °L <br /> -n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N o <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF p I, k o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE,LOT LINES. N '� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADrONMA <br /> D. C.,THE PLANS ?. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,Cyam, o (, <br /> MUST BE SIGNED AND DATED BY THE OWNER.NOTE: BUILDING/$TRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICBE <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 8[/AAA'' �j`S) ° <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITlO�/AcQ�A' <br /> ISSUANCE. ATION IS RESTRICTED ALONG SHORELINE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGET ` <br /> O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ci <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 9 nm0cDat7M <br /> m <br /> 3 nm Ox <br /> 6. in <br /> E '! E m <br /> 7. O <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> oi <br /> C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize <br /> that this information I 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 liab ich may be a result of the County of Burnett relying on this information I am <br /> providingJ� t' <br /> on. I agr to pe it county officials charged with administering county ordinances or other m <br /> m : m <br /> authorizeaccess to a ab a ascribedpremises at any reasonable time for the urpos ofinspection. - oSIGN HER (date) <br /> (si ature of owner or building contractZONING Ael <br /> i»in w in ro <br /> N (T N N OO <br /> U10(n m OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERIAIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> ►11Q i ��I -}'U (-)Ct l �-t.o l 0-lip-b3 <br />