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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admil iistrator -CD o0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER j 5 y TELEPHONE LlO <br /> Rt <br /> > rl O <br /> MAILINGADDRESS <br /> r � <br /> 0 <br /> PROPERTY ADDRESS C :P X <br /> O <br /> LEGAL DESCRIPTION(see tax receipt) Sed. 3 >O.,v, jq (? 6v L1. <br /> DWELliNB/Btftt GARAGE/ACCES 3ORY STRUCTURE X ADDITION ❑ N O <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRR�A..D�II��N,,G��❑ CAMPING UNI SUBDIVISION `y,, <br /> STRUCTURE/ADDITION USE: �� & �,5br e on 0 <br /> (Home/Cabin; Co m rci Business; Bedroom; ; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VI W) O n S• <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AN INDICATE m <br /> NORTH(N). rA o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)B ILDING(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(OHW )OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETL AND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK( T)AND DRAINFIELD(DF),AND ALL DISTANCE S TO �-1 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 1 QJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED ANDS OW AREAS TO BE GRADED OR FILLED. Q N /y, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,1 HE PLANS 0 ue\% <br /> MUST BE SIGNED AND DATED BY THE OWNER. F i <br /> o 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DON WHEN � o ( � � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELO . Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMEN S WITHIN 60 DAYS OF PERMIT / „ (� <br /> ISSUANCE. v I Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS ESTRICTED ALONG SHORELINE. a <br /> 3 NO GRADING OR SHORELAND ALTERATIONS ARE ALLO ED UNLESS SPECIFICALLY / ^1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V V <br /> SETBACK AREA. <br /> 5. <br /> X C3 � D O a O S <br /> > > 0 �° af, m <br /> 6. � x�3 am �c _ 3 <br /> p N C N N O 7 <br /> Z C N ry O [ O .i <br /> 7. O m <br /> I declare that this application (including an accompanyings hedule has been examined b me and to the best of m ! O <br /> PP ( 9 Y ) Y Y � P p C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ccuracy of n » <br /> all information contained in this application (including any accompanying schedule)and I further declare that recognize m mo <br /> that this information I am providing will be relied upon by the ounty of Burnett Wisconsin in determining wt Aher to is <br /> sue a permit. 1 further accept all liability which may be a resu t of the County of Burnett relying on this infori urtion 1 am I o <br /> providing in this application. I agree to permit county officla s charged with administering county ordinanc is or other ' ,o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of nspection. <br /> --�-- L <br /> SIGN HERE .y <br /> e+ n <br /> (sigrMjure af ow er or buil contr ctor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> 6iw w m c:` <br /> CO N O 0 O <br /> TOWNSHIP PERMITS I 1AY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE QNE N EAR FRgM DATE OF ISSUANCE <br /> Pt fmTa- -4- �e Yee✓ Pi c-Le "P bLj 7a.,n ze- Smh i7 � d 7 <br />