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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of toning Administrator 'U o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> w <br /> c <br /> r l m <br /> OWNER ..D� A /�� TELEPHONE 71S,LI'A�S"'�; 3 m y <br /> m' / / <br /> MAILING ADDRESS S� C jC�/ k i V � S !/VIS S Y4062g F <br /> /`, ` <br /> PROPERTY ADDRESSPIZ? 4 y 44 f t <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ® G/ARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ CD <br /> c <br /> TYPE OF PERMIT(S): or <br /> FILLING/GRADING ❑ AMPING UNIT ❑ SUBDIVISION ❑ L <br /> Lo <br /> STRUCTURE/ADDITION USE: 4 Ir o (� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) w ` v <br /> BUILDING CONTRACTOR: m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 71 SHEET OF PAPER. ANY INCOMPLETE OR n w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ` c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t� <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( tV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. O <br /> v � _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o LI <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH 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 ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK <br /> AREA &sL �C. C t� <br /> m <br /> V �V �� <br /> 6. // /I (� 3 /N <br /> 0. <br /> a m C w w 0 <br /> ° T `• m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m ^� O <br /> PP ( 9 Y ) Y Y c ` C) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of JOE a» <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �' m $ ,E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determiningwhether to Is- m r` <br /> sue a permit. I further accept all liability which may be a result oft a County of Burnett relying on this iformation I am E E ' <br /> providing in this application. I agree to permit county officials cha �Nr � _ y-ordinances or other m ? B <br /> authorized perso have acces to a above described premise so i' f `p se of inspection. -n m o <br /> �S I m B <br /> SIGN HERE I d' <br /> ature of owner or uilding contract ) JUL t � e) ' a <br /> ZONING ADMINIS ATOR (nl v <br /> BURNETT COUNTY ' Cn o o <br /> �QfC� 'fD ti TOWNSHIP PERMITS MAY BE REOIXOMNG ) (, <br /> � THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />