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Burnett County 7410 Co. Ra. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 1 o <br /> APPLICATION FOR LAND USE PERMITS 3 IL11 / C [� < <br /> OWNER b v\c1Ct---11 Q �/(V�1�2 1 TELEPFKKJE � J I IO,J—'()q q o �y <br /> MAILINGADDRESS I�{,La Vf <-- I �/ � f I v toV� <br /> PROPERTYADDRESS ��� S gyi� Lr� <� <br /> LEGAL DESCRIPTION(sce laxreceipQ sc yY /U <br /> DWELUNGIBUILDING ❑ GARAGEIACCESSGPYSTRUCTURE ❑ ADDITION 9 .1.1 gal,/Wae� w <br /> TYPE OF PERMIT(S). f4 YN p <br /> FILLINGIGRADI G ❑ CAMPING UNIT ❑-1 St�BDIVISION ❑ �enlGtll'hY1Q I'b�%DDira - (I ` <br /> STRUCTURE/ADDITION USE. �rCh QP(Yl 'IIlI1�QCL/m0✓i ✓✓ x/1'1 D fpJ <br /> (H me 1r, IF ; Commercial stn s; Betlrdoml Dec ,ala) I oY Q✓Q.l v <br /> BUILDING CONTRACTOR <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN Pr X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3. <br /> ILLEGIBLE PLOT PLANS WILL Be RETURNED. P y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om $ <br /> m R 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN DRAWN TO SCALE. m m s <br /> ]. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(N8)ANO INDICATE _ <br /> CNORTH IN). <br /> o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO ryrl 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I V, z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9J <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO J <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS CT y r <br /> MUST BE SIGNED AND DATED BY THE OWNER. F t <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q. _ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT. a 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q. <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. IO rL <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. t5 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER G <br /> SETBACK ARE <br /> Q� lrL.s 1 VhFjAc`fJ/ <br /> m <br /> o R T 2 A <br /> T' _ m <br /> I declare that this application(including an accomp an in schedule has been examined b me and to the best of m <br /> PP ( 9 Y P Y 9 1 Y Y C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of °' A <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize (�(1 'm in <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o y <br /> authorized person to have access to the above described prep Isms at any reasonable time for the <br /> Tpu p/ose of Matadiion. m <br /> SIGNHERE <br /> { /{ . n <br /> ,no re oly or building contractor) <br /> ZONING ADMINISTRATOR tJ IIF' <br /> TOWNSHIP PERMITS MAY BE REQUIRED I <br /> IS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />