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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M c Z <br /> APPLICATION FOR LAND USE PERMITS 3 p <br /> r <br /> N � <br /> OWNER 'f 6;6-0,U 4je TELEPHONE SZ—FP <br /> MAILING ADDRESS /O �Z S �{�y/7/� AIL- //1'0' SS 3 <br /> r � <br /> I � o <br /> PROPERTYADDRESS _ S . SI Iver <br /> aI.3 a . q <br /> LEGAL DESCRIPTION see tax receipt) Csn'l V. <br /> m <br /> DWELLING/BUILDING ® GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ I rn <br /> TYPE OF PERMIT(S): <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: ' So <br /> (Home/Cabin; Commtria�usiness; BB om; <br /> 1 y Deck; etc.) N <br /> BUILDING CONTRACTOR: <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) O m <br /> 90 <br /> � a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m ,ZZj <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In <br /> NORTH(N). C v n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I 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 41 <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. o ^r <br /> D o Y'VVVJ��� <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN n o <br /> NEEDED. GJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oI <br /> CONDITIONS OF PERMIT: sCn <br /> Q <br /> t/1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT [ o j <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY , 3\ <br /> PERMITTED. 0 <br /> l <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> xl W r) r DO O <br /> m <br /> N C N N J <br /> 7. <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — U, I O <br /> PP ( 9 Y ) Y Y G) v l <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n N 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- m In <br /> 0 : <br /> sue a permit. I further accept all liability which may be a result of the Coun of Burnett relying on this information I amrl: m o <br /> providing in this application. I agree to permit county officials charged tri ce or other ` m <br /> authorized pers to h e access to the above described premises at any t' ection. `D <br /> r a : <br /> SIGN HERE D <-A <br /> n <br /> (signature oKgfvfier or building contractor) JUN L fytpp date) 0 <br /> ZONING ADMINISTRATOR DU <br /> V [11RJ <br /> BURNETT COUNTY <br /> O N VI W W N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING ONO T N N <br /> THIS PERMIT SOALL EXPIRE ONE YEAR FROM AT OF ISS` NC <br /> Inth U, g rear 6-8- <br />