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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> OWNER 111iL rlRi`/4,1/n Alm TELEPHONE <br /> m <br /> MAILING ADDRESS 13S��1 Gdssnin2Yr (may A (� '�, MtM� sSlz'{ £O <br /> 0 m <br /> L/ 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 5 � c <br /> CD <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ W o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CL <br /> STRUCTURE/ADDITION USE: _ Dfr- ) o <br /> (Home/Cabinommercial Business;Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: AJIw LGVvC F/Zme <br /> 0 <br /> 5 <br /> iu <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> My <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n o A <br /> m m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT�OR, ETC.,THE PLANS 00 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI TIOYGQ o 0 W <br /> NEEDED. �! <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BEL �`r � <br /> OW. 9k� o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN ISSUANCE. 60 DAYS OF PERMIT �co A, ) �® <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ON/Q U'Y" • J <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 /> ETBACK ARE,Q. <br /> 6. m W 0 Mai m <br /> 7. Z o 0 �o <br /> T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o y m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n v, <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- fD <br /> sue a permit. I further acc t all liability which may be a result of the County of Burnett relying on this information I am 00 <br /> providing in thi a c n I agree to permit county officials charged with administering county ordinances or other <br /> authorized pe on a cess to the above described premises at any reasonable time for the purpos of inspection. . . <br /> T� 0 : <br /> SIGN HERE m <br /> (sig ur of owner or buil contractor) n <br /> (date) <br /> ZONING ADMINISTRATOR l( u/�'✓ r��/' (\�7 <br /> N U tN N O O V <br /> TOWNSHIP PERMITS MAY BE REQUIRED {^'��I <br />