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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> �� N <br /> OWNER &uI�r`�% �/ ' T�N�7 <br /> s'E TELEPHONE <br /> MAILINGADDRESSd9/ ./lU� / j/Qtl�� <br /> PROPERTY ADDRESS G�17O 7XAlln/ Ae <br /> LEGAL DESCRIPTION(see taxreceipI) / I� /( /r�9?I <br /> U Cn <br /> C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o <br /> TYPE OF PERMIT(S): y = <br /> C <br /> FILLING/GRADIN CAMPIN U T ❑ SUBDIVISION ❑ a <br /> � <br /> � My <br /> STRUCTURE/ADDITIONOSE: _ u <br /> o' <br /> Ho /Cabin,Commercial Business;Bedroom; Deck;etc.) Cn _ <br /> BUILDING CONTRACTOR: <br /> m <br /> v <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 /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> c <br /> n c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TZ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m v <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 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. 9 J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS N <br /> 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. pp <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO ANONSITE oNEEDED. � <br /> J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. (� <br /> CONDITIONS OF PERMIT: Z <br /> _ O Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1r1A 1 3 II/j1 <br /> ISSUANCE. <br /> 2. REMOVAL BURNETT COUNTY <br /> CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <br /> 3. NO GRADING <br /> OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS <br /> PERMITTED. SPECIFICALLY ZONING <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ///�y�A .` �y� ( Q C /� <br /> 6. — �...Yl /1.l C.RI � c '_ _ J—� V 3 m m m c>i my nD O -0 <br /> lJl� B am come <br /> 7 .N C y : O S <br /> 2 N N O _ t0 <br /> 7! < M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t� — »' p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of . o� d, S <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize <br /> (I`J�' . C o 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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am o�1 d:` <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 1 d <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. (D ti <br /> -n o <br /> SIGN HERE (.1/�JL(/z'l/l a J-?it a f� / _ _/i 7 1D <br /> w m . <br /> C <br /> (signature o r building contractor /� c (date) CL <br /> ADMINISTRATOR r- <br /> u' 0 <br /> 1 fA fH fA fA 0 N <br /> O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �S// 0"' � 0 <br /> -:� a3�s /a- <br />