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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v OZ <br /> APPLICATIO FOR LAND USE PERMITS 3 <br /> L `7- kpiso N <br /> 0 <br /> OWNER <br /> TELEPHONE <br /> m <br /> MAILING ADDRESS 5-IM30 v) <br /> r m <br /> PROPERTYADDRESS 17410lqGlnson Y l <br /> -y <br /> LEGAL DESCRIPTION(see tax receipt) i7- oA -/6-/ ---O o.�5/7T1/d R�� CC7O-P2 s cn <br /> / <br /> 1 n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE �C ADDITION ❑ �� o <br /> TYPE OF PERMIT(S): c 0 <br /> v <br /> FILLING/GRADING 1:1CAMPING UNIT ❑y SUBDIVISION ❑ a <br /> . fes/ �O TD c <br /> STRUCTURE/ADDITIONOSE: x o <br /> (Home/Cabin; Commesbal Business; Bedroom; Deck;etc.) U) / 1 <br /> BUILDING CONTRACTOR: <br /> Se '- <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. *t — <br /> O — <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> na <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> t7 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;° <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 11 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 Y.J <br /> MUST BE SIGNED AND DATED BY THE OWNER. C� <br /> f 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Uj <br /> ISSUANCE. <br /> PERMITTED. <br /> 2. REMOVAL OR CUTTING OF TREES AND VE ETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIO S ARE ALLOWED UNLESS SPECIFICALLY U,J <br /> 9 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m m 0 CaF m <br /> m 010 <br /> 7. Z N o N j o -1 <br /> T G M <br /> I declare that this application (including any ac ompanying schedule) has been examined by me and to the best of my rr 11\\ G. A <br /> W <br /> knowledge and belief it is true, correct and com Mete. I acknowledge that I am responsible for the detail and accuracy of m n in c <br /> all information contained in this application(inc uding any accompanying schedule)and I further declare that I recognize m C o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- fD <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized p access to thq.Abovec escribed premises at any reasonable time for the purpose of inspection. 'D <br /> o : <br /> 9- <br /> C),SIGN SIGN HERE a <br /> (signatur owl=or building contractor) (date) <br /> ZONING ADMINISTRATOR clan IU9 <br /> _ �_I) <br /> Q N Cnn NNOO <br /> Cn O UI 0 O O <br /> TOWNSHI PERMITS MAY BE REQUIRED C1 <br />