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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> y O^ CW3' <br /> �7 N <br /> OWNER g0 L TELEPHONE - S— <br /> MAILING ADDRESS r . -S�r . \ <br /> PROPERTY ADDRESS J S9 S NOy>1 l�J t � l•` i <br /> `J <br /> LEGAL DESCRIPTION(see tax receipt) Lot 1 ) cs NM VISP23y GLCI 7-yoqq-15- <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION IC]I rvn' o <br /> TYPE OF PERMIT(S): 1 0 <br /> FILLING/GRADING ❑ CAM IN U IT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: H o m Qi -h bh o <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> 1 I r m [] <br /> BUILDING CONTRACTOR: Q AQ_ ['�o TS � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 814 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O A <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> C1 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <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 o <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. `!.J <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 O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> F I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o 41 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z �j J <br /> CONDITIONS OF PERMIT: o93 <br /> I <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. \ � (n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. 1Y.+ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m coned o- <br /> p N C y y 0 = 3 <br /> 7. Z C in O . <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my f — =' in; p <br /> Glc v ; C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of '� � m � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 7 m f m <br /> Y <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> [ <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 /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized Pers <br /> to have access to the ova described premises at any reasonable time for the purpose of inspection. <br /> m <br /> n : <br /> SIGN HERE n <br /> ��-L-O$J <br /> (sig-n-a-t�u're of owe r buildin8 contractor) (date) <br /> ZONING ADMINISTRATOR �J(I�Y� Q.�(Cj a n <br /> ON(fin W(�J N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED do N o u, cn u, o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />