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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v a Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> o <br /> N <br /> OWNER ,ru \/.O IC�m.GI TELEPHONE / I5—Mr— q7(p/�'1 <br /> � �- / m <br /> MAILING AD ( <br /> DRESS l I I �rU l �� �� � FO <br /> PROPERTYADDRESS SAP-E <br /> / / ) 'I1 [ <br /> LEGAL DESCRIPTION(see tax receipt) /t-L 3 �l I�1 Oa lora (Shdr's sttiO/U lLd� (1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION05 <br /> ❑ n <br /> STRUCTURFJADDITIONOSE: � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) U) <br /> BUILDING CONTRACTOR: )q80 <br /> m <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR m3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O .. O <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m (r/nt <br /> n a V' <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <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. 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. C> <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N d <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. O n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o W <br /> NEEDED. �K <br /> VN <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1} <br /> CONDITIONS OF PERMIT: (� <br /> Iry1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 3% <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK <br /> ET B A C.Ky�A—Rj.AREA.. <br /> CD mc0i � am <br /> 6. m 3 n m Ox ;a <br /> -o <br /> (OD Cy � o' � 3_ <br /> 7. z �+ mo <br /> o Tom : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 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- <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to ha>T access to the above&described premises at any reasonable time for the purpose of inspection. ° o <br /> CD <br /> SIGN HEREd' <br /> y <br /> -16 - Oo2 <br /> (signature of n r qVibuilding contrac (date) ,' <br /> ZONING ADMINISTRATOR I i <br /> EA(A EA N <br /> N (T N O O <br /> (T O (T O O <br /> TO SHIP PERMITS MAY BE REQUIRED <br />