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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOA LAND USE PERMITS ° <br /> N <br /> H <br /> OWNER J 5 /' )1• 1 TELEPHONE y�y 8- 7 Z S n �✓ <br /> JJ m_ <br /> MAILINGADDRESS 236-77 I`78c(uerT� �4>1E 0-D 5k'it Z-nme WT <br /> o <br /> PROPERTY ADDRESSZ �i(n77 /`�d4r�L�l�e, /20. s�P// [ f//4e L,—Lr syR71 <br /> LEGAL DESCRIPTION(see tax receipt) F F Te �� p 38 Q l SC S E r <br /> f� r <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ElADDITION Ely o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: Ft-- c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ' <br /> BUILDING CONTRACTOR: ?. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A N W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � <br /> m n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). c 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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. A o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE { HEN g <br /> NEEDED. <br /> IV <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: Jtrt c P p' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS Of 'C •J U 7�+ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL COV TY lQ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ����(a N, r V!j a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5V C. <br /> 6. RM Sn m go F m <br /> RM <br /> 3a .mm <br /> o m Cy <br /> 7. Z inmoi ?m =1 <br /> 9 it`s i i i MM <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cn: ` ; O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize i m$ : G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m i <br /> a€ <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 ? ((/1: <br /> providing in this a plication. Is to permit county officials charged with administering county ordinances or other <br /> authorized person have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m O <br /> SIGN HEREJISTRATOR <br /> f�i , /S _ Q 1/ m m <br /> (sign a of owner or buildin tractor) (date) t 0] <br /> ZONING AD <br /> I TOWNSHIP PERMITS MAY BE REQUIRED N o ` _o <br /> 7_ 0 Y THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />