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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U L7z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> y <br /> C <br /> OWNER LTELEPHONE 7/S to Ej(p — }J/ v <br /> d <br /> m <br /> MAILINGADDRESS 5"7 p _ O <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) ,(`iLx` 8 _ / 7 1V ZI-F 9^p l—3f40 CD <br /> DWELLING/BUIL GE/ACCESSORY STRUCTURE 1:1 ADDITION rn o <br /> TYPE OF PERMIT(S): \\\\\\ c� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> n <br /> STRUCTUR ADDITION USE I K.Y- 0 <br /> (Ho a/Cabin;Commercial Business;Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: p/t <br /> Z � <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 /> 71 'o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Q n <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M <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 m 3 <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. :E (� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. — o <br /> v M' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. <br /> 5. <br /> A nr DODv10 <br /> 6. $ 3 cL Ox a ;J <br /> a m C N ^ o 3 <br /> 7. z y m ° ' <br /> P T 7J <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 .n C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <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 liability which may be a result of the County of Burnett relying on this information I am v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 9 <br /> authorized person to t1aXe access to the above described premises at any reasonable time for the purpose of inspection. m <br /> o : <br /> m m <br /> SIGN HERE <br /> (signature o o ner or building contractor) (date) <br /> cV <br /> ZONING ADMINISTRATOR 1 tT1 ! <br /> J EA(H EA di—N <br /> N (INN N O O <br /> N O U (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />