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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -V o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> TELEPHONE p q C <br /> O <br /> O <br /> MAILINGADDRESS �,C6 � 0 3T a� �AN e i �p„�/✓S ���►? �S1�3 r <br /> �/J 0 <br /> PROPERTY ADDRESS Jy�j/ / ! Pa G/O -eC !f . �7,c9r-�'e✓ wax <br /> L o7'$', 271,47- I!�' /fE'cs✓o� G r e k 7�c i t s <br /> LEGAL DESCRIPTION(see tax receipt) \ M <br /> m <br /> " a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREADDITION ❑ /r (no <br /> TYPE OF PERMIT(S): W <br /> a <br /> FILLING/GRADING ❑ CAMPIING�rNI T ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: � <br /> D,/ V V —IA .)"a A -f) lave/ 0 <br /> 0 <br /> � � (H a/Cabin;Commerctal Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: �J//5 Pp/✓f/�v ��°d �S o� J� t7/Y1 �S <br /> i <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> lI m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> '—r v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGv <br /> S)TO m 0 <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <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. pp <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. l' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS OV <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 00 <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 OOCv <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER d <br /> SETBACK AREA. <br /> 5. <br /> mmioma �vm <br /> Om Ox 0 <br /> 6. 3 &I'-°. � CyNo � 3 <br /> M 0 <br /> 7. 0n'� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myO <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n rin <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mCDy <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 w <br /> providing in this application I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have cess to thiegOve described premisq4t any reasonable time for the purpose of inspection. o : <br /> m � <br /> C�7-D - <br /> w w <br /> SIGN HERE z 03 a <br /> (signal re of own or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N N O O <br /> V+ (lO O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />