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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> N <br /> OWNER !�O GG/t 7� L \/LA 4TELEPHONE <br /> MAILING ADDRESSC <br /> Z3� L ID�� ,, �� � w/ {G�s <br /> r+�i� ! Aµ r• yw k <br /> 0 <br /> ` 0 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> rz (D <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREX ADDITION ❑ y 0 <br /> TYPE OF PERMIT(S): cQ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑'t SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) rn <br /> " � m <br /> BUILDING CONTRACTOR: Ste/Y —o-S /f '- <br /> d <br /> m <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. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n C. <br /> -n 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 fD <br /> NORTH(N). <br /> to <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 00 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. 0 \, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: .0 nn� <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 /> SETBACK <br /> 5. <br /> J ; ddoonvv <br /> 6. CDf m <br /> 6 N C y N 0 3 <br /> 7. Z N O O 10 <br /> j� M <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 ( 'Ut d v> C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 oOi <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> 0 : <br /> authorized person to hav access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> SIGN HERE <br /> 0. <br /> (signature of o4ner 0rP4 <br /> din ontr t (da ) <br /> ZONING ADMINISTRATOR 1dj AAAa� <br /> fA EA EA fA�N <br /> N V 1 N N 0 0 <br /> RN O U 1 V t O O <br /> TOWNSHIP PER ITS MAY BE REQUIRED <br />