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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vQZ <br /> / I i APPLICATION FOR LAND USE PERMITS 3. <br /> (, Il' 3vi� y 9;y <br /> p s <br /> OWNER 44-10L �i(�'� LG TELEPHONE CJ C°G — j�� p VJ <br /> MAILING ADDRESS <br /> M <br /> PROPERTYADDRESS F110 A� In <br /> LEGAL DESCRIPTION(see tax receipt)�p` V6 <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ "�' r �'�' 3 I rp o 1 y <br /> TYPE OF PERMIT(S): O Q <br /> FILLING/G ING ❑ CAMPING UNIT��SUBDIVISION ElSTRUCTURE/ADDITIONOSE: �sJG <br /> X X y. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) co <br /> m <br /> BUILDING CONTRACTOR: <br /> Z <br /> (D <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. 0 Z Jam{ \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CD �1J <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n \ A <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 /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 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. Q O <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 1 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 ) <br /> v, 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> � c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITUj <br /> ISSUANCE. Uj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. N <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER kn <br /> SETBACK AREA5. . l/ <br /> ckl <br /> d <br /> 6. $ 3 nm 0a <br /> (D y N p <br /> 7. Z N N O O <br /> O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m in c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o v <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 �: d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authoriz ve access to the above described premises at any reasonable time for the purpose of inspection. m m 0 <br /> o : <br /> i CD m <br /> SIGN HE �.- z3 DY d' <br /> (signature of owner or uilding contractor) date o. <br /> ZONING ADMINISTRATOR <br /> fA6%di(0�N <br /> N (TNN O O <br /> NO (T CTOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />