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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER /_��14 6S V//? TELEPHONE Z��'— <br /> MAILING ADDRESS <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 o, o <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Ca ; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: S m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T '3 t <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m _ A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> l� <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. 1 P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO n` <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 0 o I <br /> MUST BE SIGNED AND DATED BY THE OWNER. lTl� W <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q c VJ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ) <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O Q� <br /> ISSUANCE. I iT Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. v I O <br /> 3 NOGRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY n ' O <br /> PERMI <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER /W <br /> SETBACK AREA. <br /> 5. <br /> 6. m x3 am )sam <br /> v =, C: , 0' o ' 3 <br /> 7. Z c m o �o <br /> o m i m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of ; n ! "' : 5i <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize N 5 : G <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 0 o <br /> providing in this application. I agree to permit county officials charged with administerin county ordinances o other m <br /> authorized person to have access to the above des ribed premises at any reasons e e i i n. <br /> T <br /> Di <br /> SIGN HERE <br /> (signatu of o r�rr o�r7building <br /> �contractor) -1 (dat ) [ 0 <br /> ZONING ADMINISTRATOR �/ I �1 'I�I(A n("I(A/1 � h�� ^? 1 2005LLJ <br /> OO N (ll W W Nip t <br /> TOWNSHIP <br /> B REQUIRED <br /> �3U 77ETTTCNOUNT'` <br /> THI ERMIT ALL�e-FXP RE ONE A RO DATEOF c�uSSNIJA CE'G G <br /> �e�n,;�-SHALL -le( ►' E�llzg -�0 Df�z <br />