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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> Vl 0 <br /> N <br /> OWNER GCoe C TELEPHONE ",6 n <br /> v <br /> d <br /> MAILINGADDRESSCD <br /> 3 CS <br /> r m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) r <br /> v� tiw �s— �5 ^ / 6 <br /> C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE uS7 ADDITION <br /> TYPE OF PERMIT(S): ti s' <br /> FILLING/GRADING ❑ CAMPIN UNIT ❑ SUBDIVISION ❑ a <br /> sh �ci ' C i a'x a ' / beck ao' <br /> STRUCTURE/ADDITION USE: n <br /> 0 <br /> (Ho /Cabin; Commercial Business;Bed r om; Deck;etc.) c <br /> BUILDING CONTRACTOR: GC'O we.7 r_ C /3 e, y q , '-� <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ;a <br /> Om <br /> T a <br /> t. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IDL <br /> o z <br /> NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF -o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 0<11 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN n o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o <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 /> 6. m d M o M n f m <br /> 7. �' mC: ^ 093 <br /> Z y m o ' o <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my o m� m <br /> —4 : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v, 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- m m <br /> sue a permit. I further accept all liability which may be a result of the County tt Burnett relying to 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. m <br /> m '. CO <br /> O <br /> SIGN HERE <br /> C : <br /> 0k <br /> (signature of owner oebifilding contractor) Cl <br /> (date) <br /> ZONING ADMINISTRATOR VIM f IcfYl l/��(1 <br /> -r fA EA fA fA�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED O o <br />