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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T o� o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N � V <br /> UT 0 <br /> OWNERMjkAf\ TELEPHONE S D�_ b$� o <br /> CD <br /> MAILINGADDRESS 2 tj �W�v��0.•\� \V� \ �Q LA Y-"\• SJ I Z7 <br /> PROPERTY ADDRESS 4-7 9 0 <br /> Nva/ y Sy sCL��oh 3 t ,+ot,+..�,•p <br /> LEGAL DESCRIPTION(see tax receipt) `` (t ` n�f CJ ) o' <br /> L.S ti-S 1 r no W G.1'� 0.rQ 1�tlr��-1n O't G,0. f QVC'.✓` rCD <br /> DWELLING/BUILDING ❑ GARAGE/A ESSORY STRUCTURE -Z"IV` ADDITION ❑ ( -� <br /> TYPE OF PERMIT(S): a� ' <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVI N ❑ - <br /> /� N <br /> STRUCTURE/ADDITIONOSE: �v 0 <br /> (Home/Cabi o c'al ess;Bedroom; Deck;etc.) ( <br /> BUILDING CONTRACTOR: Pov\c <br /> Z <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> ?i O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <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 o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 PLANSI <br /> MUST BE SIGNED AND DATED BY THE OWNER. to ° C� I <br /> o 7i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAy1 *0kIE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ��/l SS/l V Z NNS <br /> CONDITIONS OF PERMIT: 4PR 0(11 <br /> 1 <br /> ISSUANCE. <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P NS <br /> 'Y 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINEZ �C;O C^ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �N/NG UN� <br /> PERMITTED. (/ <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. W <br /> 5. <br /> M m <br /> g 0 > a -0 <br /> m <br /> 6. <br /> 3 n 2 Z 9 a <br /> (-Op C N N 6 3 <br /> 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 a ^ : N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o mm <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 o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> n) <br /> Q <br /> SIGN HERE AFLA pj0j 7003n <br /> ( r atilre of ner ui Ing contractor) (da e) <br /> ZONING ADMINISTRATOR en cn <br /> fA fA fA EA� N <br /> (T O <br /> L' 0 N NOO <br /> V1Vt00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED - - <br />