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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. ) <br /> N � <br /> N <br /> C <br /> C N <br /> OWNER ) Y /k/1 kA TELEPHONE <br /> TELEPHONES <br /> a_ 7J O <br /> MAILINGADDRESS �y' � S L� � �n Q � <br /> 0 <br /> PROPERTY ADDRESS J b fj .r <br /> Fjou /of / mU a3 S C'S S <br /> LEGAL DESCRIPTION(see tax receipt) J S �! ter <br /> o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ [n 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> y� <br /> �Jp T <br /> STRUCTURE/ADDITION USE: -U C S�' ° <br /> (Home/Cabin; Commerci Business; Bedroom eck etc.) m <br /> J <br /> BUILDING CONTRACTOR: p / �/ �U S P r m i <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OIn <br /> o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) FO m \ 3 <br /> CENTERLINE OF ROAD,(C) BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM I OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCEE 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.,T E PLANS o CT <br /> MUST BE SIGNED AND DATED BY THE OWNER. r <br /> O � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN = ° (� <br /> NEEDED. 1W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <br /> CONDITIONS OF PERMIT: (L' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> Tm O r D O D O -U <br /> M m n n a m <br /> 6. a <br /> 7. Z C y 0 Oto <br /> O N TSG ;1I <br /> __ n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the he of my ej C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and a curacy of <br /> all information contained in this application(including any accompanying schedule) and 1 further declare that I recognize m 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn <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 o <br /> W <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have accesil to the above Oscribed premises at any reasonable time for the purpose of inspection. r a <br /> n <br /> SIGN HERE <br /> signature of caner or <br /> building,contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> Flan ( .' <br /> C, O N U W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED C o N u <br /> THIS PERMIT SHALL EXPIRE O �E,JYEAR FROM PATE OF ISSUANCE <br /> pum rl 'i• l _✓ ✓na tty ' 0 Vv'/-.o 1 0 moi. <(v�i Gj -b <br />