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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 10 0 0 <br /> APPLICATION FOR LAND USE PERMITS . -;.ii <br /> H o <br /> N <br /> C <br /> / / ,{I/I /�F Cf (D <br /> OWNER W 1 I` 1 Q �`�SOV� TELEPHONE S^ — Tu /' ®[ �� o <br /> ('/ J <br /> L / J 41-e✓.'e&) MA) -5-r1 6 O <br /> MAILING ADDRESS S � ©D �Q (� L� �A I1 , `\ r <br /> (� <br /> � C o <br /> PROPERTY ADDRESS 2 q 6 /6ry -3 w" It CL h"ItII <br /> J ,r F Cn <br /> �1 <br /> LEGAL DESCRIPTION(see tax receipt) S QC-Y,ba.. Yo sale. � l•� .� O � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ U 0 - <br /> TYPE OF PERMIT(S): JJJ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> N <br /> STRUCTURE/ADDITION USE: Q I"o- <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> 2. <br /> SPFBUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SYS X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 Q O <br /> -A UI <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m j3 <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N gJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0. o t <br /> MUST BE SIGNED AND DATED BY THE OWNER. - <br /> ? � <br /> J <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN = ° o <br /> NEEDED. 1 O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 9 p <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Com/ <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. X W y M 0 m a : m <br /> CD <br /> x3 <br /> 6. a 0mCN � 05 <br /> Z c m o m -i <br /> 7. P m Tom : .'0 <br /> cf, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n a ° C <br /> c D <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize J m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- s <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 c <br /> providing in this application. I agree to per it county officials charged with administering county ordinances or other ° ET <br /> m <br /> authorized person to h e ccess to a ab a described premises at any reasonable time for the purpose of inspection. -n m <br /> n : <br /> ' n <br /> SIGN HERE 9,1NCD <br /> n <br /> (signature of ow r or building contractor) (date) W <br /> I• <br /> ZONING ADMINISTRATOR Cin: i;ifl <br /> O0 IN O <br /> TOWNSHIP HERMITS MAY BE RE I �� a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM �S <br />