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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS N ° ° <br /> r <br /> m O <br /> y <br /> C <br /> OWNER X77n .t zE7 u/- Z-0 'Ap _ l TELEPHONE ,Z JV _7f1 <br /> MAILING ADDRESS Je96 6C, 8,' ,/, k-e� 7PX?IgI _ N O <br /> o m <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 7�/ ri <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I ADDITION ❑ 1 <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a �. <br /> STRUCTURE/ADDITION USE: -'�(�,f in: <br /> (Home/Ca n; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SH ET OF PAPER ANY INCOMPL TE OR / b <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Sr Orr 'j gj I -/0 (J�I� jisryli l/LF -t <br /> f/une /D-/S`tet/ 7a m jjoe 34gc � 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW /0 <br /> 0 F.r -77t�n. &k— J 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n Z <br /> � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n �bm <br /> NORTH(N). 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 <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 o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. i <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> N O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT RjW <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> XI fDOr > 0DO -0 <br /> 6. m C m m 0 m a E m <br /> m x <br /> omDCer3 <br /> 7. : o' <br /> Z Crn (Do <br /> m : -nom . .m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - - � 0 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o n u, : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <br /> in C <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 mo <br /> providing in this application. I agree to permit county officials charged i an es or other m CD <br /> - <br /> authorized person to have access tot a above described premises at a{ty I t f It nspection. D <br /> (D m <br /> T a <br /> SIGN HERE CDa <br /> gn ture of wn r or building contractor) OCI M (da U <br /> ZONING ADMINISTRATOR l�f <br /> BURNETT COUNTY <br /> fA 69 fA EA� N <br /> TOWNSHIP PERMITS MAY BE REQUIREDZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />