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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> — o <br /> m <br /> OWNER A Q-r-� TELEPHONE <br /> F/ / m <br /> MAILINGADDRESS QSS3 Hp.L E 6 VE <br /> �0 I <br /> PROPERTYADDRESS 64 Z3 Mld- 'td� .✓ Rd SIR F,✓ (A)r' sy 9'72- <br /> LEGAL /1 II``pp( W , <br /> DESCRIPTION{see tax receipt) rc7"ar �7 TOwn/� � " lo <br /> a <br /> 9 <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE J,ol ADDITION ❑ (n <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: SHFD yl-It Ll. JeY Sh<e 71 Lrye <br /> (Home//Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �A,41eg5 k7• TS m. J VI <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m \p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cn o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m <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. p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 09 <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. o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o I n <br /> NEEDED. A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �1 <br /> CONDITIONS OF PERMIT: <br /> t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. d <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 /> M WWoaf <br /> C0m <br /> > 00na <br /> 6. M F3 n0 0 ' _ .'g <br /> no 00 C y N O7. <br /> j 3 <br /> Z C m N O = O <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m 0 <br /> PP ( 9 Y ) Y Y S 'c ! c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of [ m n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m0 <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 /> m <br /> authorized person to have access to the above described premises at any reason/ c I n. <br /> i i i i > i <br /> SIGN HERE � n <br /> er n <br /> Is n ure of o r building contractor) (date) 1 r <br /> ZONING ADMINISTRATOR Z 1 V <br /> . . . . . . . <br /> fA fA fA fA � N <br /> O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY o u o u u o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUNG <br />