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Burnett County 7410 Co. Rd. K, No. 10 , Siren,WI 54872 Office of Zoning Administrator -0 0 G Z <br /> APPLICATIO FOR LAND USE PERMITS 3. <br /> r <br /> ti <br /> c <br /> OWNER / <br /> (�✓ e v, TELEPHONE <br /> v W <br /> m <br /> MAILING ADDRESS O <br /> PROPERTY ADDRESS „�t(S w° Ci CC-- <br /> LEGAL DESCRIPTION(see tax receipt) `/ N LJ Al"j <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 40 <br /> TYPE OF PERMIT(S): rY� <br /> FILLING/GRADING ❑ C WIDING UNIT ❑ SUBDIVISION ❑ I a ("`. <br /> STRUCTURE/ADDITION USE: o? / d v s7 be-c-k y iD fc-x s <br /> ( oma/Cabin, ommercial Business; Bedroom; Deck;etc.) y <br /> d <br /> BUILDING CONTRACTOR: O �ul¢v S <br /> m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 3 <br /> O <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n V <br /> m _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). c n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \v <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS P ANNED 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. o <br /> 1 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC NE WHEN o Q <br /> NEEDED. /��f� n , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. p� �5 / o <br /> CONDITIONS OF PERMIT: ',^ U fQ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDT REQUIREMENTS WITHIN 60 DAYS OF B ` <br /> ISSUANCE. F"' -vl CC <br /> 2 REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL19410 , CO(J � Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> ,,VV''VV�`77 <br /> 4. NO STRUCTURES, INCLUDING RETAINING VVALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> g, m n� iv > > <br /> m 3 am 01 A <br /> 7. N C y N O <br /> Z ,/. N O t0 <br /> n 2 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (, — ti A <br /> knowledge and belief it is true,correct and co plate. I acknowledge that 1 am responsible for the detail and accuracy of G D r`, i -., C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C o <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m m M <br /> O : <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 application. I agree to permil county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. " = <br /> T <br /> N O : <br /> SIGN HERE 9Lon <br /> (signature of owner or i contractor) date n <br /> ZONING ADMINISTRATOR <br /> (A v, <br /> EA <br /> (T( N(A 0 N <br /> " N .n N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />