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Burnett County 7410 Co. Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER —re tZ Js?l/ C�Y7w o0 <br /> W KJ TELEPHONE <br /> MAILINGADDRESS Z&ej Q(pnpu� �� r /n�1 X15 �° O <br /> r m <br /> PROPERTY ADDRESS '�eqYV) �� o <br /> Q <br /> LEGAL DESCRIPTION(see tax receipt) p CS IlU 2 ..7���s ; Cl) <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE L'7 ADDITION ❑ <br /> � v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: r4.4 rcA6 �OYI c <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> / w <br /> BUILDING CONTRACTOR: m'-/S 'Y `f- 67<G4� YY?G4/2-TI/j 2. <br /> 42 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE ORCD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> y S <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) C <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m D <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 <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 r(""R�� <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Dom, N O <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. 3 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. ° W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: Dq <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT \ O <br /> ISSUANCE. t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. ETBA <br /> CK AREA. <br /> 6. v;>vaov <br /> 7. <br /> aCc' ow' � <br /> w <br /> T� m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my c r» O <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of w C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i mEr E o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- CD S <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person tfif have access to the abovedescribed premises at any reasonable time for the purpose of inspection. m 0 <br /> lU�l/ " o <br /> SIGN HERE m D <br /> (signature of o r or building contractor (date) a <br /> ZONING ADMINISTRATORC�h/ <br /> (A fA fA fA-N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> g choin�oo <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />