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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 <br /> Office of APPLICATION FOR LAND USE PERMITS zoning Administrator o <br /> 3 ,-- <br /> 0 <br /> UT N <br /> OWNER ° V <br /> C <br /> TELEPHONE a �1 <br /> _ \7J <br /> MAILING ADDRESS 2V � <br /> PROPERTYADDRESS m' <br /> LEGAL DESCRIPTION(see tax receipt) / ! C L I <br /> R f fl,/ of <br /> DW G ❑ ADDITION N <br /> TYPE OF PERMIT(S): ARAGE/ACCESSORY ST UCTURE ° <br /> C') 8 <br /> FILLING/GRADING ❑ CAMPING IT ❑ SUBDIVISION El FL� <br /> STRUCTURE/ADDITION USE: `�,., - _ <br /> i l L' I'1 <br /> (Home/Cabe <br /> in;Co mercial Business;Bedroom; Deck; <br /> BUILDING CONTRACTOR: � � � <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. <br /> � 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> N vV <br /> C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 cL <br /> p Z� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 6 <br /> NORTH(N). <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 U <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Z <br /> BUILDINGS,ROADS, LAKE, LOT LINES. ° <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> QS <br /> MUST BE SIGNED AND DATED BY THE OWNER. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> (� <br /> 0 <br /> Co o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o t <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. L� <br /> CONDITIONS OF PERMIT: Z <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 4 <br /> ISSUANCE. I �- <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 /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 5. �(/�1✓/✓Lt *16111 <br /> U CD d d 0 v o. o v <br /> 7. $ 3 nm x ? m M <br /> o mCyyo � 3 <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my Z y ° ° <br /> knowledge and belJ <br /> ief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ° : d, A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- c m ' C): M <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m . i m <br /> providing in this application. I agree to county = O <br /> 9 permit coun officials charged with administering county ordinances or other d <br /> authorized person to have access to the abov cribed premises at any reasonable time for the purpose of inspection. <br /> - i m to <br /> T <br /> SIGN HERE m O <br /> m m : <br /> .2 — f^ i <br /> (signature o <br /> r building contracto) '\ E = : <br /> (date a <br /> ZONING ADMINISTRATOR <br /> i <br /> Vi EA 69 fA�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED Niro <br />