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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. = <br /> r <br /> N � <br /> 1_ fii-� SE,., 5 G <br /> OWNER TELEPHONE Q S 2- ti 3 j -3-10$ a � <br /> O l� <br /> n m <br /> MAILINGADDRESS t' , O BOX t31� )'YI/Na .S� <br /> iverb"kA rn 3q 3 v O <br /> o <br /> PROPERTYADDRESS 13 S�'C�/ C'Ty R-O E }� <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) �' N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ICJ. (p 0 f� <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> FLtlllrJt: a A <br /> STRUCTURE/ADDITIONUSE: CA4ijr , ICOOt' PiT4LA Tv Gjli -No "biijbuRt AR[,4 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> m � <br /> BUILDING CONTRACTOR: Ct)"tT JL e.—1 ,%" <br /> 3 � <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. i <br /> kCC z M C? <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 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)TO m J3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I Z <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. ( d <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. +'o £ I <br /> o * <br /> BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 9J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: .,\�" <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT SrJ CS T W <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REOUIRED WATER ~ <br /> SETBACK AREA. <br /> 5. <br /> m y iu n m a i m <br /> 6. m x 3 ii m 0 a m A <br /> 9 p N Cy N 0 = <br /> Z C N A O - = t0 <br /> 7. O m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP , 9 Y ) Y Y E <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <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 E d ` 0 : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hav ccess to the above described premises at any reasonable time for the purpose of inspection. ' m 'n <br /> r <br /> SIGN HERE 11 O n <br /> ( gnature ner or building contractor) (date) o <br /> ZONING ADMINISTRATOR I((Y-) F`Qn <br /> ��fA ER fA 6i�N <br /> CONO � fWTN O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> P�irn�a 1.e jl-,Lei P ie" tAP bt, La vg J erlser) g ar o 6 <br /> 11- MW rt r -1I^tnl'-- <br />