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Burnett COUnty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> (D <br /> (D. W <br /> OWNER TELEPHONE 71f $ — ir d <br /> MAILINGADDRESS 1,4,1,!5912'A- /� S�/ I S�Q�� O <br /> /y rIC/� /f <br /> PROPERTYADDRESS ��/C )9L A ,� <br /> LEGAL DESCRIPTION(see tax receipt) CD <br /> l�� 3 y I O ArLiL, A � l�N rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ GC(JUJ O N 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ nSUBDIVISI/ON ❑ <br /> STRUCTURE/ADDITION USE: K, x <br /> BUILDING CONTRACTOR: Q <br /> l o <br /> Home/Cabin; Commercial Business;Bedroom; Deck;etc.) U <br /> d <br /> Z <br /> V <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 _Q <br /> O <br /> XI <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m myt� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mo <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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o�f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI MAY BE DONE WHEN uv <br /> NEEDED. Z -. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. VEE <br /> o <br /> CONDITIONS OF PERMIT: ' ���lll <br /> 1 ISSUANCE.DRIVEWAY IT MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF E IT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL ftp <br /> 3 PO GRADING <br /> MITTED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZEA(�' CpLJAI C) <br /> TY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATEk Q <br /> SETBACK AREA. fA <br /> n D o D o v <br /> 6. 3 am yam ;a <br /> ry C <br /> 7. z ym0 ' <br /> T� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 (A <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m " o v <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 <br /> providing in 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. fD ? <br /> m o : <br /> CD m <br /> SIGN HERE <br /> (signature of owner or buil Zonto ( te) a <br /> ZONING ADMINISTRATOR <br /> Lt . . (A v+ <br /> (A(A(A(A — N <br /> NLnNNOO <br /> (AO (T Cn00 <br /> TOWNSHIP P RMITS MAY BE REQUIRED <br />