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ON COMPUTEWSCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> CD <br /> N � <br /> y <br /> / C <br /> OWNER TELEPHONE n o <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) -ev( OT :Z 5eC+10 4 d y 'ib R \ m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE K ADDITION ❑ P-)i <br /> N o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: Dec YC Ia/� �llJf o C- — <br /> (Home/•C'abin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: -T 1 G If <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a u <br /> T Z <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 F <br /> NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn B <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. <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. f 1 <br /> o =3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: O O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT o <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. u1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5 offt\J 0j2C.,[C <br /> (Dm <br /> 6. m 3 a Ela m <br /> a m Cy w o• S 3 <br /> 7 Z v o <br /> o T <br /> - m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ;� W 0 f-n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 Ln m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> providing in this application. I agree to permit count officials char gd,� k6 a Burnett relying on this information I he r v sue a permit. I further accept liability which may be a result of the Count of r <br /> P P tY Yam <br /> p g ' pp g p y g � c�minrs ,rn ,c_..._ ordinances or other � <br /> authorized person to have access to the above described premises t riaii m rr M� )•pose of inspection. m <br /> m o <br /> m m <br /> 69 <br /> SIGN HERE 1 Z <br /> i <br /> gn ure of n r building contractor)i AUG 2 7 (date) <br /> i �y <br /> ZONING ADMINISTRATORBURNE1 <br /> { S <br /> Q COUNlY <br /> ( I b9 EA N <br /> TOWNSHIP PERMITS MAY BE RE 6IR <br />