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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> o <br /> N <br /> OWNER 6k_65 ((� ) 17`rti{S TELEPHONE y O 30 c o <br /> soyz <br /> MAILING ADDRESS T�-140 ff17—t:7 �)qO afgo MA1 <br /> l r m <br /> 0 <br /> PROPERTY ADDRESS I <br /> -Pt <br /> LEGAL DESCRIPTION(see tax receipt) s � f 1J, I Cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ W c o' <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRAAD'INGG ❑ CAMPING UNIT 9 LSUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: ' CAV — LWGLef oZ003 <br /> (H a/Cabi ,Commercial Business;Bedroom; Deck;etc.) W <br /> d <br /> BUILDING CONTRACTOR: <br /> _ <br /> 'v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> z y r C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 90 p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <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. 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. F Q <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. n <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 /n <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 5 m 0rro0 > 0 -0 <br /> 6. 3 0-CD <br /> m N N <br /> 7. Z inmo <br /> o � 2 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of rr 11 m 0v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize W: 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 v <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 /> W <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 described premises at any reasonable time for the purpose of inspection. r fD s <br /> CD <br /> 0 <br /> /� r m <br /> SIGN HERE d1iL_ /l A/Y�rl-s/ 5 /3 U /63 d' <br /> signature o o ner or building con c r) (date) e <br /> ZONING ADMINISTRATOR <br /> fA fA <br /> us 64 - N <br /> N(T N N O O <br /> (T O (T N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />