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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of zoning Administrator D Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> (� <br /> F o 0 KJ <br /> OWNER 1" // ,11 yf- L i- TELEPHONECD <br /> m <br /> MAILINGADDRESS p�PoZ3 Ald Gq/(� 'Q! // f�l� /� ,/- O <br /> PROPERTY ADDRESS �/g/77E nn 1 <br /> t e <br /> LEGAL DESCRIPTION(see tax receipt) m r <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �c o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING NEW <br /> UNIT ❑ SUBDIVISION <br /> IV ❑ �: �- <br /> STRUCTURE/ADDITION USE: EW ifC)O-C— o � 7' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> c' n <br /> BUILDING CONTRACTOR: ? �. <br /> v �l <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> O O <br /> ITI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T z <br /> n �0 <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) BUILDING(S)TO m (� 3 <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. Z <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 Q) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o t <br /> O 0 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o ^� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. zI <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <br /> ISSUANCE. p 1 <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 REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m W 0 r D 0 DQ O <br /> m <br /> m x 3 a 2 x n M A <br /> p m C y �' o S <br /> 7. z cy � o <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n <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- m i rn t7 <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 : <br /> �: m o : <br /> providing in this application. a to permit county officials charged with administering county ordinances or other <br /> m' : m : <br /> authorized erson o he <br /> t m <br /> P bove described pr ises at any reasonable time for the purpose of inspection. G <br /> -n a ; <br /> m D <br /> SIGN HERE �� n <br /> (s' a e wrier or g contractor) (d e) r o <br /> \: 0 <br /> ZONING ADMINISTRATOR <br /> 8'-aa f 6Grd,d, 'N <br /> P7 <br /> O N c l W W N O <br /> �1 ' :to4lol TOWN IP PERMITS MAY BE REQUIRED c>o M C c� M O <br /> 3" '� sctut p ich <br /> /'7.9I THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN E, C )a a/-Dy <br /> l4-S9 �c t ;r_ 1Cap/ 1470 f>y /Vt��>' TjIli <br />