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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> // ` , a <br /> OWNER CIIJ/ � TELEPHONE <br /> MAILINGADDRESS a.90a r n Je— VL("' Sp—cr,rix V, 9C Vy 3 <br /> PROPERTY ADDRESScm <br /> LEGAL DESCRIPTION(see tax receipt) IfA V. to <br /> — ,g -( q <br /> �G <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION U� In 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S BDIVISION <br /> 59. / n C <br /> (v9 av1 <br /> STRUCTURE/ADDITION USE: � I.,-> �n 7� <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck; etc.) W 1 <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 _r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m ;o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W W 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ` Is'- 3 <br /> CENTERLINE <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 l <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 J 0 Op <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. 2 Q <br /> nJ ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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 O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 06. 0 m m ori n MO a° m <br /> _O O� C y N o = 3 <br /> 7. Z C n m O <br /> 0 N n <br /> s n ; € m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m F^ 0 <br /> PP ( 9 Y ) Y Y E �2 : � : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of ; m n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c i m <br /> that this information 1 am providing will be relied upon b the Count of Burnett Wisconsin in determining whether to is- <br /> P 9 P Y Y 9 �[ [ ? G): s : <br /> sue a permit. I further liability which may be a result of the County of Burnett relying on this information I am m ; o <br /> providing In thisapp' anon. 1 gree to permit county officials charged with administering county ordinances or other ; m <br /> authorized person have a ss to theabove described premises at any reasonable time for the purpose of inspection. m 'a <br /> T <br /> D : <br /> SIGN HERE ' /0/5 6-�r f^ <br /> (signatur canerlQflding contractor) I ( ate) <br /> ZONING ADMINISTRATORn(n <br /> V gfNnONNNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THI PERMIT SHALL,EXPIRE ONE YEAR FROM DATE OF I SUAN i <br /> ��rv).i�' � its ,bmf celr,��� 11-3-DS <br />