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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O V <br /> N V" <br /> OWNER ,' 1 � � TELEPHONE giZ.1 <br /> O <br /> MAILING ADDRESS,.? t �`a ���((/ D <br /> < r m <br /> PROPERTY ADDRESS S�r►�.e, ItZ I10w LAC P r'` b1 IQ 111lnlQ- /"/L I �j <br /> LEGAL DESCRIPTION(see tax receipt) v' <br /> 00 <br /> DWELLING/BUILDING 11GARAGEIACCESSORY STRUCTURE F1ADDITION I,�J <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADING ❑ CAMPING UN/IT 11 SUBDIVISION <br /> L ❑ �` <br /> STRUCTURE/ADDITION USE: �l�C�oSi0L G C-� n d <br /> / (Home/Cabin; ComM,6rcial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: 1 <br /> 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. p <br /> NQ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a 3 <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> gt <br /> NORTH(N). U) <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 Z <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 /> 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 f <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° F <br /> o flX <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 4 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. JI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 0 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X cm an d n 0 a 0 -0 <br /> 6. m x 3 n m n m ;0o 0 C w m o <br /> 00 <br /> 7. o m m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — cz : E : JO <br /> PP ( 9 Y ) Y Y G) , : -4 : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a N : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 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 s <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 O <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m n <br /> m D <br /> m a <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> fA lfl fA EA� N <br /> O N 0 W W N O <br /> O U O N (II VI O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU CE rG� �In �OS <br /> P?-(rn lei( Pic" u(o Ioy 1r1�lUf� � �_a a <br />