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Burnett County 7410 Co. Rd. K, No. 102 Siren, WI 54872 Office of Zoning Administratoro Z <br /> APPLICATIO14 FOR LAND USE PERMITS 3. <br /> w O 6� <br /> N <br /> N <br /> OWNER f-LA CSZ' I TELEPHONE �� p \' <br /> t C, <br /> MAILING ADDRESS N y <br /> O 0 <br /> PROPERTYADDRESS 1 , o <br /> I ' <br /> LEGAL DESCRIPTION(see tax receipt) :PGov LcD1` 3 L 4%� ��J CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ZI ADDITION ❑ J <br /> TYPE OF PERMIT(S): '/ ( n <br /> FILLING/GRADING QCAMPING UNITE] SUBDIVISIONAe-�;c , y'. <br /> STRUCTURE/ADDITION USE: O✓ ^' �AtA ltv2 <br /> ( ome/Cabin; Commer ial usiness; Bedroom; Deck;37'd' G 6x1 U) <br /> BUILDING CONTRACTOR <br /> v <br /> MD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> -n <br /> T � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTAN ES TO BE SHOWN OR DRAWN TO SCALE. �0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOL LOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD, (C)BUILDING(S) AEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W) SEPTIC TANK(ST)AND DRAI AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW ARE O BE FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINE , BUILDER, OR, ETC., THE PLANS Z. � <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN OW&E VERIFCA ION E WHEN ° <br /> NEEDED. <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 <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK ARF� ] /�jy // �,/�) / ' �p `, y/,' p <br /> 5. $O�n,cy-wtJ�.+-�(� f�rf l/"0. (�""r/) �f C� m w d cDi a m <br /> 6. � -COD C: N y o g 3 <br /> Z CD <br /> 7. P nm <br /> co : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my {1�' G) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn a <br /> all information contained in this application(ncluding any accompanying schedule)and I further declare that I recognize p _ CD 0 m <br /> that this information I am providing will be re lied upon by the County of Burnett Wisconsin in determining whether to is- N <br /> sue a permit. I further accept all liability whi h may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ° <br /> authorized person to have a s to the abo a described premises at any reasonable time for the purpose of inspection. m m o <br /> SIGN HERE a <br /> gn ure f n r ui c tractor) (date) <br /> ZONING ADMINISTRATOR <br /> 49 4n 4n 4n — N <br /> Pi M N N OO <br /> UO LT 0OO <br /> TOWNS IP PERMITS MAY BE REQUIREDW <br /> � <br />