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Burnett County 7410 Co. Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator -U o �? <br /> APPLICATION FOR LAND USE PERMITS I. r�T t`SI✓1 <br /> F <br /> +^r (��I CD <br /> / N�� l � /Pel CII��TELEPHONE <br /> OWNER o <br /> O <br /> MAILING ADDRESS � �� y� 11 �� � <br /> f 0 <br /> JY� o <br /> PROPERTY ADDRESS �� <br /> LEGAL DESCRIPTION(see tax receipt)5�C, �(�� )VLl L V / ( Nr��� AJfJpwO YLI CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION [� �cJ`J/0]' c o <br /> TYPE OF PERMIT(S): IlJ 7 Cr <br /> FILLING/GRADING ❑ AMPING UNIT ❑ SUBDIVISION ❑ <br /> n n �.j (� f/1 <br /> STRUCTURE/ADDITION USE: � I L� X (D ( x 10 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: iu <br /> v (� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m w 1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y <br /> NORTH(N). U) 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ZCNI <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. l� ° <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 t 0, <br /> MUST BE SIGNED AND DATED BY THE OWNER. n0 0p <br /> J v, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC �� N <br /> NEEDED. ��J �/ 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. S fp n` �� J o <br /> CONDITIONS OF PERMIT: /'A U / CL <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PNRNE, XJ \ <br /> ISSUANCE. / (�C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN?ON/N OVIVj,, (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G O) <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M 0ID0maFm <br /> 6. m 3 a� yam M <br /> a mCyyo � � <br /> N N O O q <br /> 7. O T 33 <br /> m <br /> declare that this application (including an accompanyingschedule has been examined b me and to the best of m — m: D <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 v, <br /> COD, � i v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> ID <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am sn <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 oescribed premises at any reasonable time for the purpose of inspection. o <br /> CDSIGN HERE <br /> (signature of ow er or building contractor) (date) o, n <br /> V <br /> ZONING ADMINISTRATOR n <br /> ` i i i <br /> Hf 61'AFA�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN / <br /> Yrr,.i led 04,oiden 9 lao3 <br />