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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 0 0 <br /> APPLICATION FOR LAND USE PERMITS oz 3 <br /> r <br /> OWNER BI)LtZ.,P / ,m tA�O� TELEPHONE / 7 -411 <br /> C-i!} <br /> MAILING ADDRESS �� ��,3 L` 110?-9/0� O <br /> G� C! U `7 r r� <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Ll ADDITION �. o <br /> TYPE OF PERMIT(S): m a <br /> I���III c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a <br /> STRUCTURE/ADDITION USE: rQtlpnyli\,/T <br /> (Home/Cabl memal B si ess; edroo D ck; etc.) N ' <br /> p q � <br /> BUILDING CONTRACTOR: DYti"l� � O6QY C I C <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT 3 rQ <br /> A H <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) 0 (n <br /> 'rt a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n p J <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C \. O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO (Am3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK (OHWM)OF o <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. * O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. '- -1 <br /> o <br /> � S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. N o <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W I <br /> ISSUANCE. f„ 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 J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m cm m ori n O D O V <br /> M a f m <br /> m x3 am xa � � <br /> 7. Z c m o N o 3 <br /> m <br /> I declare that this application (includinS any accompanying schedule) has been examined by me and to the best of myyr : D <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> v, <br /> all information contained in this application (including any accompanying schedule)and I <br /> her declare that I recognize m 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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other '" I <br /> authorized perso to have access to thea ove described premises at any reasonable time for the purpose of inspection. ' <br /> m m <br /> D : <br /> SIGN HERE m <br /> LU <br /> (si ture f own r building contractor) (date) o [ <br /> J <br /> ZONING ADMINISTRATOR <br /> O) O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o O <br /> THIS PERMIT SH:TLV IRE ONE YEAR FROM DATE OF 1SSU CE <br /> 'a `��F"a sd�1(hi 9 <br />