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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 < <br /> V rT <br /> _ r <br /> N » <br /> N <br /> OWNER }2,1I e- TELEPHONE <br /> MAILINGADDRESS SS7� , I { � t Q <br /> ,7bo�� <br /> � e-)IOU) lq�� )el9 �len � )1^_ ` �/d7%3 � r � <br /> PROPERTYADDRESS i ` o <br /> LEGAL DESCRIPTION see tax receipt) <br /> i V l� ' &X.- <br /> et�t�tA �ol LnP/ant� ctd�(t�0{.� V,/iaQe c ) /Y <br /> DWELLING/BUILDING . ADDITION m o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> f�0/37C N: <br /> STRUCTUREIADDITIONOSE. 0 d�" <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> En <br /> / m <br /> BUILDING CONTRACTOR: F61"6LE h-f /n:3 2-500, L7- °\ d <br /> v <br /> m <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. 0 <br /> x H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> ?I O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m `? _ <br /> NORTH(N). y <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 p Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 P <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. 49 <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. co F <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <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, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> n O Dn O <br /> 6. N F 3 n N F n m ;, <br /> 0 omcN `." o � 3 <br /> 7. Z c rn � o c ,o .i <br /> =_ m : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; cj q O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m a, <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 d o <br /> providing in this application. I agree to permit county officials charged with admi i t ordinances or other <br /> authorized person to have access to the above described premises at any reasonab I ion. T n <br /> D <br /> SIGN HERE Iny C 1111 <br /> AU o <br /> (signs r of or building contractor) 7 �r {{{atr,) i . 0 <br /> ZONING ADMINISTRATOR 1 U LUI[ �i I I I <br /> O N <br /> URNETT COUNTY CD N U W W w N <br /> /}� N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING (VJL/ o n o n n u o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />