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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator '10 02 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> w <br /> OWNER TELEPHONE G t c <br /> MAILING ADDRESS 97 ? iJR,. S-�- 41 1qk ClrnC) 1nn S reZl/ v O <br /> J <br /> PROPERTY ADDRESS AFY1�IVlC/1 �S� LC 4- -Lc / <br /> d �. <br /> LEGAL DESCRIPTION(see tax receipt) J� �y f e� �~ <br /> � i�r vI t <br /> 2 <br /> DWELLING/BUILDING Nr GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> 0 <br /> TYPE OF PERMIT(S): ' J <br /> 2f <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a ^'a <br /> Ln. <br /> STRUCTURE/ADDITION USE: GCt Y1 <br /> (� (Home/Cabin; Commercial Business, Bedroom; Deck, etc..) r <br /> BUILDING CONTRACTOR: /P���'j � ��5 7y k'y wilvjr I$ x W Cn <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m 0C6 <br /> n n <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m W <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 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. , <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS O > > <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o W <br /> NEEDED. v� <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. y( Q <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. or) ii e, C)k- s 6- os CC <br /> Wd � 0Oa ° m <br /> 6. 3 a a A <br /> p N C y y 0 3 <br /> 7. Z c v, 0 <br /> fD 11 G m <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myJ 2 : -: C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d �_ : �^ <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m cn <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 v i W o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person tq.,bave access to the above described premises at any reasonabtdWW fcliRn. m <br /> -n a <br /> D : <br /> SIGN HERE Fn n <br /> (sig ofwwner ilding contractor) (date) <br /> ZONING ADMINISTRATOR o MAY :a ' <br /> EA fA EA EA � N <br /> O N U W W N O <br /> WNSHIP PER S MAY BE REQUIREDRURNETT COUNTY <br /> THIS PERMIT SjHALL EXPIRE�,O,N YEAR FROM DATE OF ISS U G <br /> rna,led t,O I h le -to 7,rna-ffi y �+[��r 5-!O -0.5 <br />