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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y, O <br /> N <br /> C <br /> OW � d <br /> NER ✓ Q l,/ �/S TELEPHONE 23_3 726 0 <br /> d <br /> MAILING ADDRESS _ O�I4/ r- <br /> CD <br /> PROPERTY ADDRESS <br /> k1151 I <br /> LEGAL DESCRIPTION(see tax receipt) c <br /> J" <br /> DWELLING/BUILDING Ke GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ y o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/G IN ❑ CAMPING UNIT ❑ SUBDIVISION a 1 <br /> (� <_ <br /> STRucTURE/ADDITIONUSE: % –1 L/ Lt) <br /> � /a ka <br /> (Hom Cabin; mmerci Business;Bedroom;Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: V I/ <br /> CD <br /> v J <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. -n = /� <br /> O <br /> M H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m G <br /> T G <br /> T Z <br /> A- ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> � SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). � <br /> 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING:4 BUILDING(S)TO ALL LOT LINES,LWBUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,,(ej BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF (j <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I o <br /> -4! SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),ANDALL-DISTANCES TO <br /> BUILDINGS,ROADS, LAK-I'OT LINES. IE O <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, ETC.,THE PLANS IMUST BE SIGNED AND DATED BY THE OWNER. , , F�1 �L1NOTE:" BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE FICATIraR, <br /> D E O <br /> NEEDED. n p*, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J O`� S Z <br /> CONDITIONS OF PERMIT: SU P <br /> RNET). <br /> 1 <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERI�N'CG IJNTy <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. pp <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6. am '0 0, <br /> 3 i- <br /> � <br /> v m C <br /> T Z y M o ' o <br /> o n� A <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my –�^ A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n Fn C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 N m <br /> P P tY Y tY Y� 9 <br /> providing in this lication. gree to permit county officials charged with administering county ordinances or other o <br /> authorized perw to have e s to the above described premises at any reasonable time for the p rpose of inspection. m <br /> IV IF 1 11 m o : <br /> m m <br /> SIGN HERE <br /> n : <br /> (signature caner o b' Idi contra o) (date) <br /> Q <br /> ZONING ADMINISTRATOR (� <br /> O O <br /> 7 (V�+ N O O <br /> TOW SHIP P MITS RMAY BE REQUIRED (T (T Ov "`� <br />