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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator c� Z <br /> APPLICATION FOR LAND USE PERMITS _3° <br /> � r <br /> TT bb-bb�s �cier� <br /> OWNER OSCtl(' TELEPHONE <br /> MAILING ADDRESSCD <br /> Of , Lgth (Y uc , Osc- C wY d�('� O <br /> �1 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) Lok %-6, <br /> 3t m Acle, O'-;O, R AS <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ p <br /> TYPE OF PERMIT(S): 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONOSE: <br /> o' <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) � <br /> BUILDING CONTRACTOR: 0-To KF-0 ° <br /> �s�4 �asco�p�na <br /> U � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR C' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3. <br /> O w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ti <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). <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 7 <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: ZO <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C <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. QI <br /> 5. �J <br /> 6. z, m 0rnvavv a mO m n <br /> � m <br /> 7. 3 am 0a '° z <br /> N C yj y 0 <br /> n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (A: c�' ' A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of (` ,' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize W m 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- i i `D <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> CD cn <br /> -n O <br /> SIGN HERE o <br /> m m' <br /> C yr m <br /> (siggnnata re of voer or budding contractor) (date) a <br /> ZONING ADMINISTRATOR `!1 <br /> fA EA EA di�N <br /> N O1 N N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQU wo <br /> Aq � e <br />