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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N � <br /> LLf/1 <br /> OWNER— `1� RS 1M TELEPHONE , — n <br /> O <br /> d <br /> MAILINGADDRESS 17 0. d' ' , lkxv 0� <br /> r � <br /> 0 <br /> PROPERTYADDRESSAj IS <br /> LEGAL DESCRIPTION(see tax receipt) N—n \-n <br /> 1 <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ /' o <br /> TYPE OF PERMIT(S): %cel(�C D e�� O c� <br /> ����� FILLING/GRADING ❑ MPING UNIT 11 SUBDIVISION u r a <br /> STRUCTURE/AD ITIONUU E �0 `y o' <br /> U 11 ome/Cabin; Commercial Business,Bedroom; Deck;etc.) (n <br /> m <br /> BUILDING CONTRACTOR: '- <br /> m <br /> v <br /> m <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, m <br /> X N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> -n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S) EASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 "V <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS P ANNED AND SHOW AREAS TO BE LLED. CJ N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDEi , C THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. r o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS UST BE STAKED SO AN ONSITE V ICA'ngm MAY BE O ) o <br /> NEEDED. `p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Qv ?�Op o <br /> CONDITIONS OF PERMIT: RNJE�n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDT REQUIREMENTS WITHIN 60 DAYS OF PERM�CN/N oV NTYj <br /> ISSUANCE. S o Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATI NS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. vil <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m W `0 Ma � m <br /> 8 3 Ox <br /> 7. Z N O N <br /> I declare that this application (including any a companying schedule) has been examined by me and to the best of my � �( �j A <br /> knowledge and belief it is true,correct and co plete. I acknowledge that 1 am responsible for the detail and accuracy of m c e, c <br /> all information contained in this application(in luding any accompanying schedule)and I further declare that I recognize m : o : m <br /> that this information I am providing will be reiii d upon by the County of Burnett Wisconsin in determining whether to is- `D0 <br /> sue a permit. I further accept all liability whict may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. I agree to permi county officials charged with administering county ordinances or other <br /> authorized person to have access to the <br /> above <br /> described premises at any reasonable time for the purpose of inspection. m CD <br /> SIGN HERE � <br /> a : <br /> (signature of owneror wilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> 444fff . ffl fA . 6969 <br /> 69 N <br /> (Nle O (NT VNi O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />