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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER C m <br /> a r Y ti J 4 � � Q� TELEPHONE -7 � �- /_ r� _ �G 7 o <br /> MAILING ADDRESS a a ��sT �la� 1�X�ti �LUp 0 �lrG� " 7 � CD, <br /> !n --k> �» <br /> PROPERTYADDRESS �� 1 <br /> LEGAL DESCRIPTION(see tax receipt) tat fel, <br /> 1 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ElADDITION C 0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING CAMPINfG�UNIT 1:1 SUBDIVISION ❑ n S <br /> STRUCTURE/ADDITION USE: r(�1 cJC ► U a s+� B 4rt� �G r� e,r. Li V-J'V\� I`U or-\ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> m <br /> BUILDING CONTRACTOR: <br /> Q <br /> U <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 /> .'t1 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v (�Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. I 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. <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, CONTRACTC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. i <br /> O <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI MAY o <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. '4 ) <br /> CONDITIONS OF PERMIT: Q�nA' 9 A (1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. No uNJ�,, <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 /> X nrDOD0 -0 <br /> 6. m p1 � cci A m <br /> fD 3 a cD �c �" .71 <br /> N C <br /> 7. Z N N O 0 0 i <br /> O 21 M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the be of my C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of d n <n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o G <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 o0 <br /> providing in this application. I agree to permit county officialr i county ordinances or other <br /> authorized person t ve accesq4q jhjabove described prem' I 0-,th4a',,purpose of inspection. T m E Cn <br /> O : <br /> 4 CD m m : <br /> SIGN HERE !-19 - a <br /> I nature of o e wilding contr t �4 1 /p 2W3 ; (dateO <br /> ZONING ADMINISTRATOR /C/t7 C <br /> BURN COUNTY <br /> 0 <br /> Aq�,../ 0NNN OOOO <br /> `i' (T (T <br /> TOWNSHIP PERMITS MAY BE � J <br />