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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v Q Z <br /> APPLICATIONFOR LAND USE PERMITS 3 <br /> 952 y43 3410 y 0 <br /> CD <br /> OWNER 0,A V i D '� INN /I �' TELEPHONE 7/5 3�9 ;1 3 7© n <br /> v a <br /> 7 S6 3y , (� o <br /> MAILING ADDRESS ^,A V r f t/ `O ) C'�Oht /'P/V <br /> PROPERTYADDRESS T�'f 7 r rLo1V 0 /N r 0'j"0 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> G-L 5 L l7 - 3 &--/S ��/ <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Cn o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ ASSUBDIVISION ❑ �a/�X � ,�,• <br /> STRUCTURE/ADDITION USE: i3 M p N l�T f ' 6�-T i G w4 t10 c.'^--' o <br /> ( ome/Cabin;Commercial siness;Bedr om; Deck;etc.) Cn <br /> d <br /> BUILDING CONTRACTOR: '- <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> rl n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Wo A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOL OWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASURE WENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 . <br /> BUILDINGS, ROADS, LAKE, LOT LINES. N <br /> S. INDICATE IF A WALKOUT BASEMENT IS P ANNED AND SHOW AREAS TO BE GRADED OR FILLED. (}J 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 CIA NER. o ' <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Q� !a o <br /> NEEDED. (!11 p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Lb <br /> CONDITIONS OF PERMIT: o L <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTF REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIO 4S ARE ALLOWED UNLESS SPECIFICALLY OQ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING UVALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. m AY zo o <br /> /L� iw <br /> 6. �� /� fPil^O- � m m'r- n � af m <br /> 3 nm xafD m <br /> . Z y � <br /> 7y (o20 3 <br /> O T; <br /> declare that this application (including any ai companying schedule) has been examined by me and to the best of my �j y A <br /> knowledge and belief it is true,correct and con plate. I acknowledge that I am responsible for the detail and accuracy of m n in c <br /> all information contained in this application(in luding any accompanying schedule)and I further declare that I recognizem B o m <br /> that this information 1 am providing will be relif d upon by the County of Burnett Wisconsin in determining whether to is- m <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 (� d <br /> providing in this application. I agree to permil county officials charged with administering county ordinances or other � <br /> authorized person a access to the above escribed premises at any reasonable time for the purpose of inspection. -n �^ = <br /> o : <br /> CD CD <br /> m : <br /> SIGN HERE <br /> n : <br /> (si at a of owner i r ubffln-c tractor) (date) <br /> ZONING ADMINISTRATOR <br /> 49 69 <br /> fA fA fA fA — N <br /> �M Cn N NOO <br /> Cn0 (T Cn00 <br /> ��TOWNSHIP PERMITS MAY BE REQUIRED <br />