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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER !j7 FYI %y Fj TELEPHONE <br /> -1 O <br /> MAILING ADDRESS ��L y S. L�, ba <br /> o � <br /> PROPERTY ADDRESS 13 3-6 Y elA'y ("Do , afx W1 !Ty LV f <br /> ( P) n 01 !0 n!� 1 <br /> LEGAL DESCRIPTION see tax receipt) f)-o esrU N/I <br /> m <br /> K� n <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ U m c ¢. <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �: <br /> N <br /> STRUCTURE/ADDITION USE: r I Q SFaGN` 0 <br /> (Hom /Cabin; Commercial Business; Bedroom; Deck; etc.) in <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEETy OF PAPER. ANY INCOMPLETE O p T 9_ �_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -Q, - I M1ISa.Clua Qern.�t'te� rpr^~ O y <br /> i 29(uAl' . l�lrlk eAn�ert-.( -tc� 0�+ <br /> 0 d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �1tJe-ut b 4�LQ3 TI" m a <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO ALE. moi-16 dere .&L Vie . n E p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH C o <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 ( Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 10 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Cr <br /> BUILDINGS, ROADS, LAKE, LOT LINES. D <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. � p N li-) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS (Jl 60 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 <br /> NEEDED. �--� <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o (� <br /> CONDITIONS OF PERMIT: c-{}- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O 1 <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J �e <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK REA. <br /> 5. (N`,� m W M 0 M a o m <br /> 6. n <br /> L i 6�� m. x 3 <br /> ( /'H/ a m <br /> oN � " j 3 <br /> Z c n m o <br /> 7. o m Tr m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my � 2 ; � C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n -n, "' : A <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize : m $ m <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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j m <br /> authorized persop Va havp access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> m D : <br /> SIGN HERE <br /> (si ure of owr or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> �fAM d1 EA N <br /> W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N O ti N N <br /> IS PERMIT SHALL EXPIRE ONE Y AR FROM DATE OF ISSUANCE <br />