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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y <br /> a <br /> OWNER TELEPHONE 7��-� S Z /-7 6 0 �� <br /> MAILINGADDRESS <br /> V ICD <br /> r CD <br /> PROPERTY ADDRESS S 'Q �S ppn ofL'C.l1 9 <br /> SO(p /7S /01 <br /> LEGAL DESCRIPTION(see tax receipt) �O (o <br /> jU <n <br /> resCD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 0-17 co Sit)51 o <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING CAMPING UNIT ❑ U I'VI/SION ❑ a <br /> STRUCTURE/ADDITIONOSE: o_' <br /> (Home! bin;Commercial business;Bedroom; Deck;etc.) ti <br /> m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT ILEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n a <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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 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. D <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N qu <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. ^ <br /> to 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFOATION o <br /> NEEDED. I �` !," 1Ij <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. U Y Z v r <br /> CONDITIONS OF PERMIT: BUR J <br /> 1 RIVEW Y MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITZOI,fir r COUIVNUANI <br /> E. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Wo I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J 4 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. 1 / I\Va fir !//Q�� e lJ/ ! m W 0Ca : m <br /> ✓ 3 'a m Ox m <br /> a ry C N y p = 3 <br /> 7. Z y N O t0 i <br /> T M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that t am responsible for the detail and accuracy ofm 0 : v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m o v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD� <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 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. m o <br /> �/ m <br /> SIGN HERE ' ( y LC J—t/of-- <br /> (signa wner or uuiI it_ding c ntractor) (date) a " <br /> ZONING ADMINISTRATOR `/I my ►I �_I <br /> N V t N N O O <br /> TOWNSHIP PERMITS MAYBE REQUIRE ' c9oZ-lz3 O <br />