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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator M o 0 <br /> APPLICATION FOR LAND USE PERMITS o <br /> u <br /> OWNER G� t Filet,, V W a6er!�p TELEPHONE?15- 5�q�- �p 93-5 v 1 5S <br /> MAILINGADDRESS Q�p �/ ' �IS 5Wr m <br /> 1 ^ <br /> nn- � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) /V yt/ S / SSC p` I J % M 4 <br /> I- ' <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): a CRk <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> m <br /> 0 <br /> STRUCTURE/ADDITION USE: S I 6A Eoi�• <br /> S�� r / <br /> (Home/Cabin;Its C�me�01 Bess;Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: T' w 1-0 (t <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m � cy— <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> TI O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mm o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. AN 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS � ? I <br /> q <br /> MUST BE SIGNED AND DATED BY THE OWNER. C'- <br /> W <br /> �f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: W 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. () <br /> D ALONG SHORELINE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTE <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r <br /> PERMITTED. N <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5.& L.J (D 0r- >0 > f m <br /> B 'a 2 Ox D A <br /> 6. z yF. <br /> moa � 'c � <br /> 7. P _1 z m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my rr ''� <br /> W <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of �� 55 <br /> schedule)and I further declare that 1 recognize <br /> all information contained in this application(including any accompanying <br /> :N m rn In <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' G) : <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 /> m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other : <br /> m N : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T o <br /> m B : <br /> CD <br /> SIGN HERE a ' <br /> (signature owne or oundin c V (date) <br /> ZONING ADMINISTRATOR E»vi vA Fn- <br /> O N (TNN O <br /> D (T O(T (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />