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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 < ° <br /> r <br /> OWNERD G tir G'rMN1 1 r TELEPHONE <br /> MAILING ADDRESS 20 7,S0 Jqu-T/1 C ►V �-�ncs-7— <br /> PROPERTY ADDRESS 2(y37/s JD �3., -) / yc P, -/ J jces (.— <br /> tj <br /> LEGAL DESCRIPTION(see tax receipt) P � _+ �_ <br /> C <br /> CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): o <br /> El c � <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 60(dlTko- 26V TZ p4494c-1 (' dMell .?<%)wZi <br /> 0 <br /> /�� (Home/Cabin, Commercial Business,Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: ✓ J I AA L A) S' C4 L 7 <br /> C2��' d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR I <br /> CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) CD <br /> C <br /> C1 <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m v <br /> NORTH(N). CD <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. p Z <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. 1" O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I (� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. U 3. d <br /> -4 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION L/B HEN o o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1' r/ �" <br /> CONDITIONS OF PERMIT: g �� f �C j o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERI'i li�C® �ooS 1Ji11 <br /> ISSUANCE. (j C <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 /> 6. ;o nr D O D D <br /> M w r0i CD o f m <br /> 7. a_' y N a00 <br /> W 9 E: 3 <br /> N N . ? J <br /> Z N O O (D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o m! ; : A <br /> =cnm <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofd 2 w, S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize r m E o m <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 G : 17 <br /> G) <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above ci scribed premises at any reasonable time for the purpose of inspection. d <br /> m N : <br /> m 0 : <br /> o . <br /> SIGN HERE -- -2 cam �: <br /> (signature of o r building contractor) v. <br /> (date) <br /> ZONING ADMINISTRATOR <br /> fA fA fA <br /> N fA N <br /> O I N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o' N O O <br /> ��o v N./ cJ 0 �' <br />