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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N ° O <br /> OWNER TELEPHONE /. n <br /> o (Al <br /> m s� <br /> MAILING ADDRESS <br /> -?o zK 71 Ss�) 75 <br /> f <br /> rr..11 <br /> PROPERTYADDRESS 22/ 00,Ll <br /> W ^. <br /> LEGAL DESCRIPTION(see tax receipt) T 3 CSM 1 D 14, 1 <br /> 6& 60✓ L.T 9 Syz- 11 a- GD✓ LOT, - Z Sm-- ItZ) I <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 Q. <br /> TYPE OF PERMIT(S): o- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> 2 ^� <br /> E y <br /> STRUCTURE/ADDITION USE: o" <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> Z � � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 3 <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p <br /> T a 1 <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m A � p <br /> NORTH(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 1 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. =, 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. U\N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. £ ) <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, Z 1 <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <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. V <br /> III 5. <br /> A WOrDODOV <br /> m cmdt> mn £ m <br /> 6. m x3 nm �Oi- a � ;a <br /> a W C H y O = 3 <br /> 7. Z C in O 1 <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the be ^ ' in D <br /> Y ) Y best of m <br /> Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w' `n ; u, � C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G) <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 : o <br /> providing in this a plication. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pers o have ac ss to the above described premises at any reasonabl ti to ' m <br /> T n : <br /> D <br /> L n <br /> SIGN HERE <br /> tom! <br /> (sly2ftge of owner or building e) oa <br /> (date)dt <br /> . II <br /> ZONING ADMINISTRATOR j I t r 1 r ant AUG 5 2W5 <br /> Lj O »I <br /> X69 fA fA 69 T N <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY N N o <br /> O Ut O U tit U� O <br /> THIS.nRMITSHALLE PI ONE YEAR FROC � l�DATE FIS UA I <br /> m +- �v � i <br /> �e� er <br /> m� <br />