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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v L7z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> N <br /> OWNER ( SJ 1-�F/`1 ( � TELEPHONE <br /> /n.}-� ,t m <br /> MAILINGADDRESS rya , Ss+w �r I AjloKA MA,�w to <br /> r N I <br /> PROPERTYADDRESS / Y1/l O <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) L —_ 3 / <br /> m <br /> DWELLING/BUILDING I GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITIONUSE: e� ! <br /> (Home/Cabin; Commercial Business;Be oom, Deck;etc) y <br /> m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> -n m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> tt ''11 n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m W <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 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. <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. i <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF I �I� C�DONE WHEN j' o W <br /> NEEDED. 1 M <br /> J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. r��` J -li z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS O%R►yll_T <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR�'EE,�/�VLtI E. CQ <br /> 3 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N� <br /> f' <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER IIlJJJ111))) <br /> SETBACK AREA. <br /> 6 Q// Wln // !r^/ - C gs ' CT7� ��U�/ �O 3 a M x n T � <br /> �� c(J� o mcW : 0S3 <br /> 7. z v mo <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — p <br /> L7 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> m n : to <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ':L <br /> o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am oO <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pers n to haQ acgess to the above de%Ajimand premislas at any reasonable time for the purpose of inspection. ° ? <br /> T O <br /> N D <br /> SIGN HERE �� Z "' 01 ' <br /> (signature of ow, ding ontractor) ( te) CL ' <br /> ZONING ADMINISTRATOR <br /> fA <br /> O rA ha N <br /> (T N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> lryJ� N O U(T O O <br />