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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> VT O <br /> N <br /> Fel,« i 1 k <br /> OWNER t'1 dG P TELEPHONE&/S <br /> J v C7 <br /> d <br /> MAILING ADDRESS B&X �Q r1 Du Y L/ Z �}'-�B d <br /> / I <br /> o <br /> PROPERTY ADDRESS PJ e �S ee 7 <br /> / I o i �w <br /> LEGAL DESCRIPTION(see tax receipt) AM gr•GOkS St + Fj L/ W I l.o1 R LK Z O m <br /> +;ten o ail Gtr 2 / <br /> 1:10 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION und o' <br /> TYPE OF PERMIT(S): c 1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ?� <br /> STRUCTURE/ADDITIONUSE:_,►_/eC,k- o� <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) ti <br /> BUILDING CONTRACTOR: S e I <br /> m <br /> v <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 3 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p fi <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T <br /> o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). C } n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(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(OHWM)OF v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. $Z 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. c> <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �'U <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 2 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o �J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN T o �D <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P () <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. In <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 m m n�a <br /> 3 o.m yam <br /> m Cy ' 25. <br /> 3 <br /> 7. Z infoAct 1 <br /> o -n' M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C) A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n En C <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- 0 <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 d <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> O : <br /> SIGN HERE �& E. m <br /> ( gnat a of owner r it contractor) (date) <br /> o : <br /> ZONING ADMINISTRATOR <br /> -N) <br /> fA fA(A69 0 N <br /> O N (TNNOO <br /> O Ct, O Ut U O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />