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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> OWNER / t- C7 N '"Z-. 6— P r L c / A) a <br /> TELEPHONE <br /> o K <br /> m_ p <br /> MAILING ADDRESS a ' -41 /J F R V ck, C 1 -ba P) G{ r 10 (D j <br /> $ 1 m <br /> PROPERTY ADDRESS A <br /> 1 0 -' <br /> LEGAL DESCRIPTION(see tax receipt) D * 2 / A T b � �k,., 0 L L,0 �7L -rA7 z f; C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION 1151 a <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISI N ❑ a <br /> STRUCTURE/ADDITION USE: �3-t­b rq q _W&fion -ILD a{ ePg�( 0 <br /> (Home/Cabin;Comma cial Business; Bedroom; Deck; etc.)' m <br /> ' ^ <br /> BUILDING CONTRACTOR: L <br /> C <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD jfl <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> T a <br /> ?� o i Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 0 <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. O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I Q <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> g � <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. Z <br /> CONDITIONS OF PERMIT: g <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. (�j <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 /> o CL M <br /> CD 3 a0 % m M <br /> O m C y N O j <br /> 7. <br /> O M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` ` E O <br /> Oc 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 recognizem r ; G <br /> `f f <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J <br /> sue a permit. I further accept all liability which may be a result of the r r s formation I am ? ro <br /> providing in this application. I agree to permit county officials char d 1 e i u o nces or other `• <br /> m <br /> authorized person to have access to the above described premises d f h s f inspection. m (n: <br /> o <br /> ID <br /> SIGN HERE /!� I m m <br /> yi ` E eu <br /> (sl tura of owner or building contractor) - �) a <br /> ZONING ADMINISTRATOR I RI IRNET-T h 1 cl <br /> e3 <br /> �c rv�r r Q�_��` o E C) o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />