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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 . <br /> r <br /> o <br /> OWNER' <br /> TELEPHONE <br /> IL�G y�G.�sW W(A/7Yl te� TELEPHONE 71 J - 3a-7 —85-&q <br /> mZR <br /> �J CDMAILINGADDRESS Ca_ I'eia 63 rc- W� 5* O <br /> � O <br /> PROPERTY ADDRESS AVA E � ) <br /> LEGAL DESCRIPTIONt see tax receipt) <br /> m <br /> ( P) ► 371 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ cn F <br /> TYPE OF PERMIT(S): I Cr (�o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ q <br /> STRUCTURE/ADDITION USE: I 70 )� �Zb� 0 <br /> e(Ca inmercial Buess; Bedroom; Deck; etc <br /> ' msi .) <br /> r. m <br /> BUILDING CONTRACTOR: YM.&Dn <br /> � O <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 �. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> � T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). W 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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I 9 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o t <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. T� <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. <br /> M a f m <br /> 6. m � 3 nm �c ^: �D ;0a o m c " o 3 <br /> Z c rn o 1 <br /> 7. o m `nom : A <br /> _ C, : m <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 <br /> cn <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize E my <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m cn <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am d o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i <br /> authorized perso have access to the above des ribed premises at any reasons I er the ur ose of inspection. m n <br /> T <br /> CD a : <br /> SIGN HERE <br /> signet o caner or bu' contractor) / (date) W <br /> ZONING ADMINISTRATOR <br /> EA 69 EA fA N <br /> da <br /> OOU OG T <br /> T01#NSHIP PERMITS AY BE REQUIRECBURNETT COUNTY <br /> THIS PERMIT SHALLEX�IRFONfMpA�E Qre1 ��nait+Y- <br />