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Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872 Office of Zoning Administrator v C) z <br /> APPLICATION FOR LAND USE PERMITS �_ <br /> r <br /> N O <br /> tl, <br /> ! / J�{- c <br /> 0OWNERS C A/J .Z TELEPHONE d P 7 72 <br /> MAILING ADDRESS /11�r y /� /J //7 0 <br /> T r <br /> CD <br /> PROPERTYADDRESS �� e� F&' Jj <br /> 1y ` <br /> LEGAL DESCRIPTION(see tax receipt) Le T 2 0 /4 Derr L SV 4.v. Airs 3A +� Cl) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> t o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING/❑ (CAMPING UNIT ❑ SUBDIVISION ❑ �/ [�'/ �: 11 ` <br /> STRUCTURE/ADDI110NUSE: U Gl JA Y �/1J ` � "— D�� /t 7 `{ T. <br /> 0 <br /> - (Homme/Cabi�Commercial Busineess�;Bedroom;'Deck;etc.) <br /> BUILDING CONTRACTOR: / / /G(�LJ 0 0 Z f t✓/ ln� !`�S <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p O <br /> -n n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <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 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE 15(j14i)kkem a o <br /> NEEDED. t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. r ?Qn� z <br /> CONDITIONS OF PERMIT: ° <br /> � + 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT— <br /> ISSUANCE. <br /> ERMIT ISSUANCE. (r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY DO <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. �' 3 nm yam <br /> 7. Z y ' O y j <br /> O -n� .Zl <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my W �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n : v+ C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m - o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m v <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 <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 described premises at any reasonable time for the purpose of inspection. = <br /> - o : <br /> SIGN HER m <br /> � 2y oL <br /> a : <br /> (signature of ow or bu ing contrac (date) <br /> ZONING ADMINISTRATOR <br /> F»fn <br /> EA fA EA fA 0 N <br /> N N N N O O <br /> � (J10(T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />