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—v <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> — r <br /> N O <br /> C <br /> OWNER 671 iW TELEPHONE <br /> Ql / � <br /> MAILINGADDRESS �a (n 1O/ n ( �nCf _LU7 f <br /> 0 <br /> PROPERTY ADDRESS �cCA ,ef/ <br /> LEGAL DESCRIPTION(see tax receipt) Ser, a6 7`wf -7" 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 5 <br /> 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ° <br /> STRUCTURE/ADDITIONUSE: JaL ` GtC(A �CyYJ o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m r7 <br /> BUILDING CONTRACTOR: - <br /> Q <br /> d <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n <br /> ;a 4y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> 'n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 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 <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. -I <br /> F I <br /> v 0 <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: �C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� 0 <br /> ISSUANCE. ^ \ 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. IjCJ � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER 6 <br /> SETBACK AREA. <br /> 5. <br /> 6. m W 0 (D CL :E M <br /> 3 a mO� a m <br /> 7. Z N N O N f0 <br /> "n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of - o v, <br /> PP (including Yaccompanying ) g a <br /> all information contained in this application mcludin an schedule and I further declare that I recognize m o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �..+ <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 apaLkation. I agree to permit Squatyofficials charged with administering county ordinances or other m <br /> authorized pe0d6rp—haXabqe&s to the ab escribe premises at any reasonable time for the purpose of inspection. m s <br /> T O <br /> SIGN H'E CE [ <br /> n : <br /> (signature of owner wilding co tractor) (d te) <br /> ZONING ADMINISTRATOR <br /> N (T N N O O <br /> (TON (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />