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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ciZ <br /> APPLICATION FOR LAND USE PERMITS 3 g 0t� <br /> J / IG�i�LC' <br /> OWNER S 4' %� rTELEPH E�S2� 15 <br /> m <br /> m <br /> MAILINGADDRESS Z - y / �5 � 0 <br /> PROPERTYADDRESS Z7507 G <br /> LEGAL DESCRIPTION(see tax receipt) <br /> c/r t�<-.2-7 � r6 <br /> DWELL ING/BUILDINGIIppII 0 )� <br /> ❑ GARAGEIACCESSORY STRUCTURE ADDITION ICt m o V' <br /> TYPE OF PERMIT(S): c � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: 6.1E qREEti�A72 '�N6 PIC X4N4'- 'Rwr 4f-iD 7116 &ZP0a,"Y/ 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> S7� m <br /> BUILDING CONTRACTOR: re"'V4 r C <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _- <br /> O <br /> rtl y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 00 U A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) <br /> 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. 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. ) <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.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 AREA. <br /> 5. <br /> � <br /> Da O <br /> p m C y ,`� o 3 <br /> 7. Z c N m o 0 '0 <br /> p <br /> - m ! m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my D <br /> O2 P <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail C <br /> and accuracy of ; m <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 /> O <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 <br /> authorized person to have access to the, bove escribed premises at any reasonable time for the purpose of inspection. t° ' <br /> \' "dam/ t m i c, i <br /> SIGN d�o210 8 sv I a : <br /> (signa f owner or in contractor) (date) o <br /> 0 i <br /> ZONING ADMINISTRATOR 5 <br /> ONS �� O <br /> TOWNSHIP PER TS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />