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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 /> UT 0 <br /> OWNER C/�f �!� LJ h—_`7 /��, TELEPHONE �O 'r/ / / / ` - n <br /> m <br /> C O <br /> MAILINGADDRESS S� D L��/�_ Ol�rl�Jp/�C./i�'w <br /> LL <br /> I o <br /> PROPERTY ADDRESS Z7&0 J �g . <br /> LEGAL DESCRIPTION(see tax receipt) Cf) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION (o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: �7 j1�44�i ��/y�h9 .� P� 'gAgt'" 0 <br /> Ln <br /> (Home/Cabin; Commercial B siness; Bedroom; Deck; etc.) <br /> "l r ^ i <br /> (' <br /> BUILDING CONTRACTOR: ��/� u V% <br /> 3 � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> -n Z <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 m <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 <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N C,' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 7' <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. A /-� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ( 0 <br /> PERMITTED. ` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> ,/ <br /> 6. MAX LiUi A� 7U b� /�5vv � ` EnciDs �w LD � 3 r o g o z <br /> �'{I r0i � � Q � � a � nl <br /> a omc � `" o � �+ <br /> o : �, : m <br /> I declare that this a lication includin an accom an in schedule has been examined b me and to the best of m — ^ p <br /> PP ( 9 Y p Y 9 1 Y Y i G) -4 : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of J' d �_ : � : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D n <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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D <br /> -n a <br /> m <br /> a <br /> SIGN HERE S C, a <br /> (sig owner u' in contractor) (date) rcl��5:0 <br /> ZONINGADMINISTRAV-V r fJ (/ D / O N 1 W W yV JO(TOU CT O <br /> TOWNSHIP PERMITS MAYBE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE�ONE YEAt2 FROM DATE OF ISS�IANC <br /> 1� ' Y�Y lY1GU �tl +0 0"r(is �Q�C� <br />