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�d <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,W154872 Office of Zoning Administrator ' Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> �J <br /> O <br /> N <br /> / % d <br /> OWNER JAL 1t �_.4 fC2 f�JJ J bfAl t-1 -761!X A TELEPHONE <br /> MAILING ADDRESS A O <br /> i 1 W ht <br /> m <br /> CD <br /> ��� r <br /> PROPERTY ADDRESS 3 Q� ift�l�f �, I / t 1 ° <br /> LEGAL DESCRIPTION(see tax receipt) 1� PAGF_t, a F t o-> G[xr r. (-vT 3 <br /> SE Oco <br /> TYPE OF PERMIT(S): DWELLINGlBUILDING 1:1GARAGE/ACCESSORY STRUCTURE 9 ADDITION ❑ N <br /> FILLING/GRADING ❑ CAM�IXC�UNIT ❑ SUBDIVISION ❑ a /I <br /> STRUCTURE/ADDITION USE: Ift E I P6= t nra� R)( I o o <br /> (Home/Cabin, Commercial Business;Bedroom; Deck;etc.) (n ' <br /> BUILDING CONTRACTOR: (! 52. <br /> W <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n r <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n O 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 O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m d 3 <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. 5 z <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 GC7 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o 0 <br /> NEEDED. p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. y <br /> Z T <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �7 I <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. <br /> 5. <br /> 6. W ;0v0. ov <br /> 8 MO 0, M <br /> 7. CD C: O � 3 <br /> Z N N <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my O T p <br /> =rnE m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �y Y m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- n `` m <br /> 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 I m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to hav accesss�s^^to,,the above described premises at any reasonable time for the purpose of inspection. y <br /> 0T <br /> SIGN HERE � <br /> - �� 3iu <br /> (signature of o or building contracto (date) : a. <br /> ZONING ADMINISTRATOR C <br /> � fA EA d1 fA�N <br /> N V N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />