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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITSCD <br /> . . <br /> N <br /> OWNER /�A� �'7hE'yE`S� TELEPHONEiF <br /> �1 <br /> p r m <br /> MAILINGADDRESS ! �J - /yy�a S-et <br /> PROPERTYADDRESSjyt <br /> e r <br /> LEGAL DESCRIPTION(see tax receipt) / <br /> Cpm vim( 3 W <br /> DWELLING/BUILDING LV1 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ P <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ y <br /> STRUCTURE/ADDITION USE: 1 l t>ANg 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <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. -n <br /> O <br /> z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <br /> NORTH(N). y o <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 <br /> Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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 /> 5. 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 J ♦✓ <br /> MUST BE SIGNED AND DATED BY THE OWNER. �pp F L <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF]IT <br /> q C <br /> NEEDED. 777NpTHIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. °CONDITIONS OF PERMIT: JUN z 7 200 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF kn �- <br /> ISSUANCE. �URNETT COUNTY <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONING <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> !Tf <br /> m d 0(D a ov <br /> 6. c �/ / `8 3 0. �n� �An ,3/LY IL � W ° m c y ° 3 C� <br /> 7. <br /> o Tom ; M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my0 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a g ; <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : ITII <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> CD <br /> SIGN HERE �/' ^ d <br /> (signature of owner or building con tor) (date a <br /> ZONING ADMINISTRATOR VX/ D : <br /> EA fA fA fA�N <br /> TOWNSHIP PERM S MAY BE REQUIRED Z �J <br />