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715 SO A138 IC <br /> Burnett County 7410 Co. d.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 CtIJ, <br /> r !. <br /> N 0 -v^ <br /> N T <br /> J N <br /> OWNER J I G / V n TELEPHONE 2 1f <br /> rr—LL J C11// <br /> „ v 1 <br /> MAILING ADDRESS y P� /�/- ) /V O/SI h �6 5 tiC /�'') 11/ O <br /> PROPERTYADDRESSy7J <br /> q3 0 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> 2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ko llD/- B om ” <br /> TYPE OF PERMIT(S): Oi Q <br /> FILLING/GRADING CAMPING UNIT El SUBDIVISION El '�r� a <br /> 11 <br /> { F <br /> / I <br /> STRUCTURE/ADDITIONUSE: V PLAY Si .P 1 Ste— f 'IGT)LCT G{ P(� Me 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (n (` <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. -n V' <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). (a 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. o <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. C7. <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. F <br /> 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o I „ <br /> NEEDED. T DO <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> T <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� W <br /> ISSUANCE. 00 <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. ev f�� m m m m f m <br /> 6. 3 oa(Ou Ox <br /> (Dp N <br /> 7. z amQ : � <br /> p T� <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ A <br /> PP (� 9 Y ) Y Y G) B '. C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d .n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 00 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> - o : <br /> SIGN HERE d 2 16 l/ 3 a <br /> (signature of o)wmmr building contr tor) (date) <br /> ZONING ADMINISTRATOR <br /> N N N N O <br /> NON Vt O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />