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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 /> r n <br /> N <br /> OWNER cTELEPHONE 7-,S � J <br /> .3.1/r—& a c, <br /> MAILING ADDRESS a Zl7:1 C� sT T 3-r/7cJ O <br /> I o � <br /> PROPERTY ADDRESS �71 r Tr ,(��s 4�,Je-- T r CyT <br /> r i <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) �6 7 <br /> �(� <br /> (D 7 <br /> DWELLING/BUILDING fg GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ �� <br /> TYPE OF PERMIT(S): 0 �) <br /> FILLING/GRADING ❑ CAMP NG UNIT ❑ SUBDIVISION ❑ a <br /> �I / N <br /> STRUCTURE/ADDITION USE: lJyrr s L!4//n o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: to Y u f Ul <br /> �� L c2. <br /> CD <br /> CD C <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPERANY INCOMPLETE OR <br /> . <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> O v <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> n a n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m "5�` <br /> NORTH(N). C O O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m N, a <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 ty <br /> BUILDINGS, ROADS, LAKE,LOT LINES. g <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS C 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN oo <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z Q <br /> CONDITIONS OF PERMIT: P rQ ) <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' C� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Op <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. W � � > vaov <br /> fm <br /> m x3 :1D1 <br /> 00 <br /> x _n .� <br /> p� N C y y 0 = 3 <br /> 7' Z C N O O O <br /> O CD 21,<I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — o— A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m N C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- U) O <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am d o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have a t the above described premises at any reasonabl C tion CD <br /> ' o <br /> SIGN HERE �� fD a [ <br /> (signat r uilding contractor) !. (date) i Fn o <br /> ZONING ADMINISTRATOR G r DEC ^ 20 L'; <br /> wtne» <br /> EA fA W fA-+ N <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> i�o <nocn ut cno <br /> llJ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAWQ�IiNG <br />