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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator '00 Z <br /> APPLICATION FOR LAND USE PERMITS . g� <br /> N <br /> OWNERo 9 ✓Q TELEPHONE ;;6 <br /> w <br /> m O <br /> MAILING ADDRESS /0A, <br /> r m <br /> �J� 0 <br /> PROPERTY ADDRESS '/ y9l ` .. <br /> LEGAL DESCRIPTION(see tax receipt) (j �� _ QDa�� _ 0/ _.S70t� f w z../-,e � ,� in <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION Elrn 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> ^,❑/ �SUBDIVISION ❑ a <br /> bd <br /> STRUCTURE/ADDITION USE: �iOI(�Gt-�►�P 0(`1�l�c�lo( <br /> (Ho a/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: A4*1e VOL)ne'o" 9)m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> W N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> '—f o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ro j3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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, t <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. m 0 <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 0' 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o I <br /> TO <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 /> SETB CK AREA. <br /> 5. <br /> ID <br /> 6. �`�L}rC21 J v �'/ m. 3 a m x fD <br /> v mCyyog3 <br /> 7. 2 95 (a <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 a n C <br /> all information contained in this application(including any accompanying schedule)and 1 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- J <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 agree to permit county officials chargei ter unty,ordinances or other i o E Ii <br /> authorized person to have access to the above described premises of o a i e se of inspection. - c , <br /> _ o ? 0 <br /> SIGN HERE vi i <br /> (s na 6re of opnpr uilding contractor) <br /> JL ( to) o <br /> 2 20 <br /> ZONING ADMINISTRATOR <br /> sA <br /> COUNTY 0�?003- N <br /> TOWNSHIP PERMITS MAY BE REOU�WII�f(a` /00 3- u o o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE "I <br />