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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator " o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNEQ G. it 2 TELEPHONE p <br /> CD <br /> MAILINGADDRESS CJAIn P �V <br /> rUNm <br /> PROPERTY ADDRESS <br /> a5�q77 cave,12 5�rdij6P U) I . <br /> L GAL DESCRIPTION(see tax receipt) LTG W5_ . 8' 6i �'� 1 m <br /> DWEL G UILDI E/AC <br /> AR � WrR ECla AD ION aGJ ( fn o <br /> PE OF PERMIT C <br /> ( FILLING/GRA ING� E CAMPING IT E] SUBDIVISION ❑ ) ��SE SEJ OQ <br /> STRUCTURE/ADDITIONUSE: Q,✓I ' o�c3�C lO/ <br /> ome/Cabin; Commercial Business;Bedroo Deck;etc.) <n <br /> BUILDING CONTRACTOR: <br /> v <br /> m <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. T <br /> z 8 � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cn o <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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 } 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. C o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0, � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. LA <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r� <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETB5. ,/` ACS <br /> m W 0=1 00i %?a F m <br /> 6. 2 3 'nm F ° m z <br /> Z 00 00 <br /> 7. o T it <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myG)c C <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, <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o , my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I <br /> sue a permit. 1 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. 1 agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to he above described premises at any reasonable time for the purpose of inspection. ° o <br /> ro m <br /> SIGN HERE 'U <br /> (signature of ner o trac building con (date) a <br /> ZONING ADMINISTRATOR �^ /� <br /> fA fA fA 6AILO <br /> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />