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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> N <br /> C <br /> OWNER �C�4j dYf�Lr /� (3�'[— TELEPHONE 79(/ — g Z3 n (U <br /> MAILING ADDRESS 'L z�y�j /fejt 7" Z AA/Gx /!3C L XACD <br /> �/� <br /> PROPERTYADDRESS <br /> G` <br /> P <br /> LEGAL DESCRIPTION(see tax receipt) —s <br /> NA 0 <br /> a <br /> DWELLING/BUILDING Lpk GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rA <br /> TYPE OF PERMIT(S): `v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: f/Om a" o <br /> (Home/Cabin; Commercial Business;Bedroom; Deck; etc.) rn <br /> R l hetes <br /> BUILDING CONTRACTOR: m <br /> T <br /> CD <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 /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 �b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m q <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. a <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO W <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o f <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( �J <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X 0DVDvm <br /> A N n n d <br /> 6. ,p 3 <br /> -o mCN `" o � 3 <br /> 7. Z y o 1 <br /> o -n :0 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I � A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 FA <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m o 0 <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 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 /> CD <br /> SIGN HERE <br /> (signature o owner or ilding contractor) (date) <br /> a <br /> ZONING ADMINISTRATOR <br /> to�1�f� <br /> N (T N NO <br /> (TOU U <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />