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Burnett County 7410 Co. Rd. K, No. 102,Siren,W154872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> D <br /> -r- L 6s �� a <br /> OWNER k"'4 P-r � ✓ L� / e M P r--) TELEPHONE �) �'--�f 6 y o <br /> OMAILINGADDRESS • IP } 7.� 3 //9'J7 <br /> y �D <br /> PROPERTYADDRESS RP� ' [c7,�9asFy�' ��/ood 14"�d / ASS <br /> ( piy <br /> LEGAL DESCRIPTION see tax receipt) <br /> �7Dn J m <br /> DWELLING/BUILDING V GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): ry �jeJ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ O a <br /> STRUCTURE/ADDITIONUSE: 14OM 'L 0- 0 ~' <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) Cn ` <br /> d <br /> BUILDING CONTRACTOR: S Q <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n -' <br /> O <br /> TJ m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m O <br /> -n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m -s— <br /> NORTH <br /> NORTH(N). <br /> 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 N-- Z <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. r2 <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 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF, ;h6DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ! o <br /> CONDITIONS OF PERMIT: /� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OAITrR ` lDo2 / h <br /> ISSUANCE. "�/f,V�� ( V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIf}���'OV Q ) <br /> 3 NO GRADING <br /> ED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1"1111/6 Nn �1`' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. (g <br /> 6. � /� CD Wr0Oaf vv <br /> M <br /> 3nmx -. m ,y <br /> 7. Z N n1 0 � O <br /> O n` <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 0 F» <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Co O <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 o� <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T fD ? <br /> CD <br /> o <br /> CD <br /> SIGN HERE �,�,t� /`�lGte,.,. �-12 <br /> u : <br /> (sig <br /> o : <br /> nature of n or building <br /> contractor) (date) <br /> ZONING ADMINISTRATOR <br /> NaM OO <br /> Kv V ;U'Q NO (TO00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 5� 1 � <br />