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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -a 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER G I^e r- n TELEPHONE o <br /> eo� w <br /> MAILING ADDRESS 1 y p / 1/l !) O <br /> PROPERTY ADDRESS odd IJG.lA <br /> LEGAL DESCRIPTION(see tax receipt) ,� I SP b ILI /, � � <br /> �v m <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 .. <br /> Q <br /> TYPE OF PERMIT(S): (, ` ' <br /> 0 <br /> FILLINGIGRAA�DING ❑J CAMPING UNIT 1:1 SUBDIVISION ❑ W a IQ <br /> STRUCTURE/ADDITION USE: Mol� /10 A6 <br /> 0 <br /> (Home/ abin Com /ial B�sinesdroom; Deck;etc.) Cn ^ 'n <br /> BUILDING CONTRACTOR: 6*erfn-� <br /> (Home/ <br /> ; <br /> 1 <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T B. <br /> - <br /> O57 <br /> �1 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n n �? <br /> n v � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m _ ` 1 . . <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z 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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o d0 <br /> F 1C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> ISSUANCE. <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Cj <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER t <br /> SETBACK AREA.5. C <br /> 4fnr _p t5sue. <br /> s. l"It CD W 3 cL(D o Q o v <br /> a C:w m � <br /> 7. 'O (D N N O 3 <br /> Z y D O 0 <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 d in C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D <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. I agree to permit county officials h cq, ordinances or other m <br /> authorized person to ve access to the above describe rem' r t4Jg, r ose of i spection. m s <br /> �7 CD <br /> o : <br /> S1GN HERE /yy������ I p<3 P Fn <br /> G0 a <br /> (signature of o uilding contra ) (date) 1 <br /> ZONING ADMINISTRATOR �/ pG <br /> I WO <br /> U 1 r N(�T NN 00 <br /> 77U O U U O O <br /> TOWNSHIP PERMITS MAY BE RLC"�B �/ <br />