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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> qq <br /> �� r,�+ M id M/J 5�34� <br /> OWNER t�( m <br /> p / LHPHONE 71 S - v qg —7 93S 0 <br /> a <br /> MAILINGADDRESSPt (,� y i"' VLJS / �1�� vl! O <br /> / ✓� <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipcn <br /> t) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ y o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: //e k� /0 3 0 <br /> (Home/Cabin;Commertial Business;Bedroom; Deck;etc.) <br /> v <br /> BUILDING CONTRACTOR: <br /> �l aAq <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> ZI m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � <br /> nn <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T O <br /> Z <br /> t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Zo <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 b <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. F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENo Uj <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Oc <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYQ y d <br /> PERMITTED. /" <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 1104 <br /> F m <br /> ry/�./,/��f��(/ J((y 1 ',�/j }/nom JD /I(/,, / $ 3 a m x a fD <br /> 7. ""`."'W Vl��/�V C yO/ tlerj J ee O.1 'O N W y y 0 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n d, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 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 C <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ? <br /> CDCD <br /> o : <br /> SIGN HERE <br /> w nat ( ate) <br /> e of owner or building contractor) n <br /> ZONING ADMINISTRATOR <br /> fA fA fA fA�N <br /> ii� �� CNnONTNI OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />