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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O C <br /> C 0 <br /> q lD <br /> OWNER I� r n kc, V'u TELEPHONE _ Ll o <br /> _ m <br /> MAILINGADDRESS �Ll2S (USS ❑(_ —L7ri 0(' (,( �, O <br /> PROPERTYADDRESS if <br /> O4 <br /> LEGAL DESCRIPTION(see tax receipt) © U) <br /> _ m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONCn o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 1-1CAMPINGUNIT 1:1 SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: -l-Ir)m `e- AV I a 1 y a o + <br /> (Home/Cabin, Commercial Business; Bedroom; Deck, etc.) U) W <br /> v <br /> BUILDING CONTRACTOR: n 0 h C. <br /> v <br /> m (h <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> Qh <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) J Ivv� � m C �� <br /> n a F' <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m v <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. d' 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,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> o D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C' <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 AREA. <br /> 5. <br /> 6. m D a n a <br /> F m <br /> a o m cN ^ o 3 <br /> 7. Z c w m - <br /> o m Tom : m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m ; fJ <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m �_ �^ : C <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize (�\ m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- + I cn 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 (� I 1, o <br /> v 1 <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized per on to have acre s to the above descf-ib-eA premises at any reasonable time for the purpose of inspection. m <br /> -n a : <br /> m D ; <br /> SIGN HERE 11drl <br /> ( ' nat re of owne or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR - 1 <br /> ^ v+ En(n <br /> (1EA rfY 69 EA-+ N <br /> �/ O CP O Cll UI Ul O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS UANC t <br /> rn� (.24�f ih&t teayNOanl �e /x�r� S- I�'-�5— <br />