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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> co <br /> N � <br /> A C <br /> OWNER o'/ ,G �S P„ TELEPHONE /p Ja- "�J�j'- I Z <br /> Ad e <br /> 303,90 yd N <br /> Q <br /> MAILINGADDRES } Bi [ <br /> I U <br /> (j <br /> m <br /> PROPERTY ADDRESS ,yk vVsd.t1 1 0 <br /> LEGAL DESCRIPTION(see tax receipt) L-p+ 3Z �c5� GI�Yifrt. � <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n <br /> TYPE OF PERMIT(S): a <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ r <br /> STRUCTURE/ADDITION USE: 1-16/n/✓!P 0 V <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: sD �t/> <br /> m 3 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/X 11 SHEET OF PAPER. ANY INCOMPLETE OR _ <br /> T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ;a f <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. <br /> T <br /> ?t Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � X2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 0 <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 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 I <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O N 0 <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. F <br /> o S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. .". <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. rf <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. D ^ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY }U( <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X caw m 0 MOa FO m <br /> O p N C <br /> O <br /> T. Z C vi N 7 tp -I <br /> O <br /> — N : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m j r^ O <br /> PP (� 9 Y ) Y Y (]CIi i Vi c : � : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ` : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m m <br /> L7: 0 <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 s m o <br /> providing in this application. I agree to permit county officials charged with administerin count o - ther j <br /> authorized person to have access to the above described premises at any reason pri I n. T a <br /> a : <br /> SIGN HE <br /> 47 (signal a of ow building contractor) (dat_e), <br /> ZONING ADMINISTRATOR <br /> / FEB 2 2W6 <br /> / �M636i 63� N <br /> g o N N <br /> TOWNSHIP PERMITS MAY BE REQUIREDBURNETT COUNTY7` � � / / ^ <br /> HIS PERMIT SHALL 4 194 ONE In R.i te7,D�ATE Ob r-Mla./W;�(,t,td b-s <br />