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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS �. <br /> N54 CKJ <br /> OWNER TELEPHONE QA <br /> k5) JOE <br /> L n l j k w <br /> MAILING ADDRESS m� ��3 1b(i� (-CZE Jap 3� O <br /> PROPERTY ADDRESS <br /> / 7 / \� Oki <br /> LEGAL DESCRIPTION(see tax receipt)L3 as l),) �oZ tip0j`r/� l� ��fO S�/U� /L v <br /> DWELLING/BUILDING Rr GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ `[~I„ 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTUREIADDITIONUSE: 010_�kIJ <br /> C� (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: y <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p L <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O a 1 <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m w �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). to <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 CO Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. U1 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS O = o t <br /> MUST BE SIGNED AND DATED BY THE OWNER. kA c <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> 3. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �j + <br /> ISSUANCE. <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, <br /> /INCLUDING <br /> 'RETAINING WALLS, ETC.,AALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK <br /> CAREA. <br /> / �q�� <br /> 5. (.Q�l1 � � vl /r I �L� �� � 0r- D0D0a <br /> 01 n <br /> 0 9 n(D X ;;: <br /> 6.v� C y �(7 <br /> 7. <br /> Z W m O� : : M <br /> O -n G <br /> O <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)CT c . . ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 0 m <br /> that this information I 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 >; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> eCD <br /> SIGN HERE�. X1 A, W�,L \ <br /> y, in <br /> (s tura o caner or buddl nt ctor) (date) Q �' <br /> o <br /> ZONING ADMINISTRATOR �^ w <br /> "'� "(nn N N 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED d Mu <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />