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Z_ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> o <br /> N <br /> 5T ly, 1'T r��/C{I� (5kyC OKCr� <br /> TELEPHONE &., �_&7�{ / / o <br /> OWNER D V <br /> C i (D <br /> MAILINGADDRESS � 7�1 yS ( �L j IJ No B('to k ng nI 5:50_S'6 <br /> m <br /> / 2 0 <br /> PROPERTYADDRESS �� Job T o Wer P6 O(t ftk U�y <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ '-�� � 1 <br /> TYPE OFPERMIT(S): 6 <br /> c <br /> Iy Sf/I Q a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> i 25 <br /> STRUCTURE/ADDITION USE: C Llp t h <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) � <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n '3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T O Z <br /> P <br /> 1: ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N o <br /> NORTH(N). <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 j Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I <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. <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 C 0, <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <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 OF PERMIT <br /> ISSUANCE. C� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ n 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Xl <br /> PERMITTED. \ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> S BACK AREA. 7 A Q �y, <��r / a V <br /> 5. ��y Q _c a � rJ 5''i (r �Y�'Q 1 m uni m cDi n m <br /> 6. iv`� 3nm aD ;a <br /> 'O 0 C y fn O <br /> y N O O un <br /> 7. 0n m <br /> G—_ A <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 2 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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- <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 <br /> providing in this application. I agree to permit county officials charged wi g I ances or other U), <br /> . <br /> authorized pe on to have access to the above described premises at ai b i r of inspection. - o <br /> CD m <br /> SIGN HERE <br /> n : <br /> (signature of owner r ildin on ct r R Id <br /> ZONING ADMINISTRATOR / <br /> e»d, <br /> EA fA Vi be— N <br /> N 0 N N O O <br /> TONING ,Q v, acncno0 <br /> TOWNS IP PERMITS MAY BE REQUIRED a <br />