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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> OWNER 1�0 LS:R Ll \(P\ 0 G� TELEPHONE <br /> v <br /> a�� � 4 Piz A �� W s 3 <br /> MAILING ADDRESS �O <br /> r � <br /> ^ 0 <br /> PROPERTY ADDRESS /^• ` <br /> I - I <br /> LEGAL DESCRIPTION(see tax receipt) LOT l Z C 5A V --i A) 0VPk LOT L See3(F-r pA /5a1 R1vd C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION y 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> a <br /> N <br /> STRUCTURE/ADDITION USE: L-W-M 00 6Le-fj F P-0 ju <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) N <br /> BUILDING CONTRACTOR: SPF <br /> m <br /> v <br /> m <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. O <br /> A Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T a <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. () <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ( a 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. I I 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. N <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 0 <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �i o <br /> NEEDED. r 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 I <br /> SETBACK AREA. <br /> 5. -� m Wd0vno <br /> 6. J = o o a Fm <br /> m <br /> N C y N p 3 <br /> 7. 2 N N O =t0 <br /> O T� <br /> declare that this application(including any accompanying schedule) has been examined by me and to the best of my - rn A <br /> � G) Cr : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of rr d <br /> Vim: <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 <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 o <br /> authorized person to have access to the above descr' premises at any reasonable time for the purpose of inspection. m fD <br /> CD o : <br /> SIGN HERE <br /> a : <br /> (signature of own r buil ng contractor (date) <br /> 44k <br /> ZONING ADMINISTRATOR <br /> fA fA � N <br /> N N N O O <br /> NON O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED c <br /> r <br />