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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> O <br /> OWNER �CLrnPSY1LL1LEPHONE '7115r� -lam Q 6 rJ yC W <br /> v <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS&J ed � �Zj <br /> ' ! 7 <br /> T <br /> LEGAL DESCRIPTION(see tax receipt) a s `/�-- IV6 to <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ .rn 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/ RDING ❑ CAMPING UNIT SUBDI ISION a <br /> DITIONOSE: m <br /> STRUCTURE/ADf b f 1� °L b v �1�� o (1 1 <br /> Home/Cab•n;Commerc�l siness;bedloom; Deck;a c.) <br /> BUILDING CONTRACTOR: / <br /> v <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. p Q \ <br /> 3I y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jZp t t� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE X111 <br /> NORTH(N). U) <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 <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 d <br /> BUILDINGS,ROADS, LAKE, LOT LINES. S1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N od <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTR CTOR,ETC.,THE PLANS0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o' o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIIj', <br /> NEEDED. <br /> v 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. , ' c <br /> CONDITIONS OF PERMIT: e C .� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT�NE� COU // Q <br /> ISSUANCE. Jam+ \111 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �N//v OVN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> lam- 70 C) r D C £ <br /> m1 �O9 <br /> 6. m 3 am <br /> .6mC,N„ y0 - <br /> o O <br /> 7. 0 <br /> rn <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m vi <br /> L v i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m S o C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rg: <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 m <br /> providing in this application. 1 agree to permit county officials c rged with administering county ordinances or other m '; <br /> authorized person to have access to the ab9ye descritW5fp06mIsqojat any reasonable time for the purpose of Inspection. m _ o <br /> m m <br /> SIGN HERE , <br /> (signature o r or bull Ing contr c r) (date) <br /> a ; <br /> ZONING ADMINISTRATOR ���� ' <br /> �. <br /> rh <br /> (CJI N N <br /> ✓VYI � V2 �_�(P�(}�{ TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />