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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'D o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> ,/q oynX � N <br /> OWNEF2` // <br /> IJN2 n 6,--v A) C xh, I d reA TELEPHONE� g'� — rj`a p <br /> o J <br /> MAILING ADDRESS a7�/7 ' �� Low �) r ' S-//dJG3 '7 O <br /> PROPERTYADDRESS l;014 r ��-��,ek� LVI 5;—q r' ' <br /> r ; v' <br /> LEGAL DESCRIPTION(see lax receipt) Q ` <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LV ADDITION ❑ <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: �- G Q f QCj j <br /> (Home/Cabin;Wornmercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: S o—o ff b Hyl, F,� 1y h o <br /> v S <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n [Z` <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p <br /> n n m <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> n m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. (,, <br /> o <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 G <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. t <br /> I o <br /> O <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: P 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. V� <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 /> 6. m r- a) ° o cci :E M <br /> m x3 <br /> a o m Cy o 3 <br /> 7. Z c rn m 00 <br /> CD iii . : . 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. I acknowledge that I am responsible for the detail and accuracy of m n c <br /> all information contained in this application (including any accompanying schedule)and I further declare that 1 recognize m c I m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is I in <br /> 0, 0 <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 � v o <br /> providing in this application. I agree to permit county officials charged with administering county or man or other ` ° T <br /> authorized person to have access to the above described premises at any re i s action. m <br /> -n a : <br /> SIGN HERE IJ I LE1 , CDD <br /> t» a <br /> (signature of owner or building contractor) ( a e) <br /> ZONING ADMINISTRATOR V SEP 1 '5'2004 a U1 <br /> CST W W N O <br /> TOWNSHIP PERMITS MAY BE REQUINETT CnnIIOrrUNTY (jo n o o <br /> ash°1rj-THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF 19t7RMCE <br />