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I <br /> 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 /> 5T 0 <br /> OWNER G /Lf G ✓IN&I(J J D (J TELEPHONE 5' <br /> ell <br /> MAILING ADDRESS <br /> CD <br /> ,� , I 0 m <br /> PROPERTYADDRESS <br /> 3p <br /> LEGAL DESCRIPTION(see tax receipt) �c ^ / <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREI � <br /> ADDITION ❑ o <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADIN AMPING UNIT ❑ SUBDIVISION ❑ ✓�`.-�,/a �7S y�,� a <br /> STRUCTURE/ADDITION USE: X l' 3 — l ,', �C'J( o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) rn <br /> G <br /> BUILDING CONTRACTOR: <br /> m <br /> 4 <br /> ' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT <br /> y 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O `m <br /> i T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE o <br /> 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 v <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 /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2. G <br /> O > <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P v T <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 <br /> 6 Sg K AREA. <br /> / )I'v <br /> atL $ wmo �6. xa'. mM <br /> 3 cL <br /> 'O NC <br /> 7. Z N W O O <br /> T'Z 17 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my _ A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize W m o : m <br /> PP ( 9 Y ) g <br /> that this information I 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 m <br /> providing in this application. I ree to permit county officials charged with administering county ordinances or other <br /> authorized person t ave acce o the above described premises at any reasonable time for the purpose of inspection. m Cl) <br /> T o : <br /> SIGN HERE r <br /> �O 9aa2 <br /> (s ture f owne or building contractor) (date) a <br /> ZONING ADMINISTRATOR 1(n ; <br /> . . . . te N <br /> Nut N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />