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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v0 <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> - r <br /> y O <br /> y <br /> /I � C <br /> OWNER�W�� (.f/ �p ✓7 G. E 7�J -G 3 S—-7✓rZ 7 <br /> T O <br /> MAILING ADDRESS './ �� / J�Z �fl�er, f <br /> m <br /> PROPERTY ADDRESS 61 <br /> LEGAL DESCRIPTION(see tax receipt) y,Ae, 3Sy,9 4Z <br /> DWELLING/BUILDING}5,J GARAGE/ACCESSORY STRUCTURE LJ ADDITION ❑ /„ In ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONOSE: ° <br /> (Home/C bin; Commercial Business;Bedroom;Deck;etc.) rn <br /> BUILDING CONTRACTOR: 7 Lf:G �✓S � �Jy` 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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> 4---ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE ( ' <br /> NORTH(N). (n �{' o <br /> .Y 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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ` o <br /> ,t! SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO \ <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> Sr- INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Iv <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. to f ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ` o <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. l� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <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 /> SETBACK AREA. <br /> 5. <br /> X d <br /> r- ODn 0 "a <br /> d <br /> 6. R 3o-m � ;q <br /> O m <br /> CW N <br /> 7. Z N N O O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myG)c <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n Fn <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O : mo <br /> that this information I am providing will be relied upon by the County of B � CD <br /> ning_whether to is- lz: O <br /> sue a permit. 1 further accept all liability which may be a result of the Co urn�1'����i infoy�1mmation I am <br /> providing in this application. I agree to permit county officials charged, n i PO4es or other o [ <br /> authorized person t ve ac to the above described premises at reasonable time for the pu s oF!inspection. m o <br /> JUL 2 S <br /> SIGN HERE -j ' M <br /> CL : <br /> (signature of owner or uildi gcontractor) <br /> 1 � <br /> (taw <br /> �ZONING ADMINISTRAOR COUNTY <br /> �,N <br /> J N O N N O O <br /> V10 Cn cn 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />