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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 /> OWNER `� t-� I� l_"-1nA.V'VCY� TELEPHONE 6 <br /> MAILING AD0DRESS bo coo � <br /> m <br /> PROPERTY ADDRESS I i in7 D , 1 Y+ d i,hz � - Fy - 'Q-kiG)� <br /> LEGAL DESCRIPTION(see tax receipt) C) Z-) - I�., 0 L-' <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LJ ADDITION L1 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDrIVI-SION ❑ L < <br /> STRUCTURE/ADDITION USE: <br /> c (Home/Cabin; Commercial Business, Bedroom, Deck, etc.) p)BUILDING CONTRACTOR: Sal 41 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 17 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 J '� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O o s <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) It o Z r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o <br /> m 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 0 <br /> NORTH(N). m ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO �a <br /> m <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF _VZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. CEJ P <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. o <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 OWNER. 0 ( � <br /> o -I <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN � \ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> t <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITZJI <br /> �. vl <br /> ISSUANCE. � d <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. M CED W 00 * m <br /> 6. a o m N o 3 <br /> c <br /> 7. m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my (� c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of !-ri' m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize VV�� <br /> m n d <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; m <br /> lth <br /> authorized person to have access to the above described premises at any reasonab f T o. <br /> ' m a : <br /> SIGN HERE (date) <br /> ( ' n re w r building contractor) rrp trr�r�L ? <br /> ZONING ADMINISTRATOR APR f+ 211116 <br /> Q �fA EA EA EA.+ N <br /> aO N O (WT N (NT O <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT NG�UIMT,} <br /> THIS �( SHALL fXPIQ7 ONE R FR�M EUS�7✓t <br />