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Office of Zoning Administrator M 0 0 <br /> Burnett County 7410 Co. Rd.K, No.102,Siren,WI 54872 3 < <br /> APPLICATION FOR LAND USE PERMITS N <br /> N (� <br /> d `v, <br /> L � W <br /> OWNER <br /> ^/ .7 TELEPHONE 5 / 5 33 3 -da • �, <br /> O <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS / �/ •`l^ 3 O <br /> PGI G--1- a 3-- o--� ID <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) <br /> U) o 5 <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION ❑ v ' <br /> n <br /> TYPE OF PERMIT(S): T <br /> FILLINGIGRADING CAMPING UNIT ❑ SUBDIVISIONi1c) <br /> o <br /> STRUCTURE/ADDITION USE: N <br /> (H me/Cabin; Commercial Business;Bedroom;Deck;etc.) m <br /> i m <br /> BUILDING CONTRACTOR: 2 n <br /> v <br /> m <br /> 3 y� <br /> T n <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE O O ur <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m Qjj <br /> O a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o Z <br /> (� m <br /> m CD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO <br /> SCALE. <br /> C 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE CA 0 <br /> m \ v <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S) <br /> TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 C) <br /> BUILDINGS, ROADS, LAKE, LOT LINES. N <br /> 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO IL GRADED OR FILL 2 <br /> o ) <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 /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> a o <br /> NEEDED. Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a + <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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 /> ER <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WA <br /> T <br /> SETBACK AREA. <br /> fi �/ L 0 3c-L0ox Tm <br /> 5. 1 GJ4/h0 // 1//��� 0 � ooam .'O <br /> ei'�.pCL// ���/ m. v a N w T. <br /> 6. Z 2 . <br /> 7. N T m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my @ 2 nc <br /> S m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to m <br /> sue a permit. I further accept all liability which may be offs Is eharged with admin steringicountytordinancestor other <br /> the C unty of d <br /> providing <br /> 4�atlon-celslgriee to permit CD <br /> my - oauthorizedve a s tov d rib remises at any reasonable time for the purpose of inspection. mSIGN HER Odate) <br /> (signawn or buildin frac 0� <br /> F»F» <br /> fA EA fA EA - N <br /> ZONING ADMINISTRATOR 01 0 01 0 0 0 <br /> TOWNSHIP P MITS MAY BE REQUIRED <br />