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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of <br /> APPLICATION FOR LAND USE PERMITS piny Administrator (D 0 0 <br /> 3 <br /> H <br /> OWNER460 <br /> MAILING ADDRESS per, n ��,�p� �6' c� <br /> �[_(.(.-(/ ��Arr f <br /> PROPERTYADDRESS � ,Q. ) <br /> / err <br /> �� U r l A e v I G+�I1 V —1 KZ t <br /> LEGAL DESCRIPTION(see tax receipt) L� M ) Jq p��� C'L.? �k "r;,T <br /> / t V W to <br /> TYPE OFPERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> rn o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑/ xSU��IVISION ❑ 'Q _a <br /> STRUCTURE/ADDITION USE: olr G /� <br /> (Home/Cabin;Commercial Business; Bedr o Dec etc.) I <br /> o <br /> Vr W <br /> BUILDING CONTRACTOR: <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 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 w <br /> c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> Z <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) <br /> 303 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. S 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. v <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS (b N <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> lr � ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIG� a <br /> NEEDED. V" � o <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. MAY 2 2 <br /> CONDITIONS OF PERMIT: Z 1 <br /> (JRo <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT CO ) <br /> ISSUANCE. NE COUNTY ) _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ZONING <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. h <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER \J <br /> SETBACK AREA. <br /> 5. <br /> 6. m y iu 0 rb n * M <br /> 7. fD C N N O j' <br /> Z N N U 1 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o T p <br /> - N : m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m d, S <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- <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 m : t7 <br /> providing g P oo <br /> a gin this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m rn <br /> T o : <br /> SIGN HERE m m <br /> to iu <br /> (sign f own or building contractor) (da e) L^ o' <br /> ZONING ADMINI RATOR ) <br /> 4A EA fA�N <br /> O N (T NNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED "' 0 v 0 0 0 <br />