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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS <br /> ~ T <br /> N <br /> _ O <br /> OWNER `� �y ql ,�ON14 ( :/7�71O/� TELEPHONE Z- / ySy 3.S^3 v <br /> n y <br /> MAILING ADDRESS 24- Z S'cd 15zR-A).EXA#! f,0 1d1110W'/4Jt A Al <br /> _ Sj/IU 6� <br /> PROPERTY ADDRESS 9Q ZS" 4 LCL!b W <br /> LEGAL DESCRIPTION(see tax receipt) ,ev 7- &moi z 062�4(!!U S /4wxrs� m - <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE IC4 ADDITION ❑ (n <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPI GUNIT ❑ SUBDIVISION ❑/-^+ m <br /> STRUCTURE/ADDITION USE: Ph I _ I I(U o J((J x. (00 d C)(Home/Cabin; Q&mercial Business; Bedroom; Deck;etc.) Cn <br /> m <br /> BUILDING CONTRACTOR: CD <br /> v <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In - <br /> M y/ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Cj <br /> BUILDINGS, ROADS, LAKE, LOT LINES. \ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. OC N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDE E PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V IFICATION MAYBE D N o <br /> NEEDED. � ,JUN 14 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: BURNETT COUNTY <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIZONING IN <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X (00 <br /> MrrDi ODnv -D <br /> m <br /> 'O N C <br /> 7. Z N ry O <br /> O TQ <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w d, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to isCD <br /> - <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 W <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> / m m <br /> SIGN HERE n <br /> signature of owner or build g contractor) (date) A <br /> ZONING ADMINISTRATOR �A y, <br /> fA N <br /> N N 00 <br /> V• U O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />