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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator - c o <br /> APPLICATION FOR LAND USE PERMITS = o <br /> OWNEROe `J (C J - t (G C O40 4/f,^ J✓ .5, TELEPHONE -7� X6(', —yy-YP <br /> n 1� <br /> OY <br /> MAILING ADDRESS -7 3 8 7 5 7'10 4 `C J . l 5 6 � s-Y p ( 3 0 <br /> �r m <br /> � o <br /> PROPERTY ADDRESS !l9 <br /> LEGAL DESCRIPTION(see tax receipt) �j�- L cs J� P,9-LI o c <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ U) <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ � <br /> N <br /> STRUCTURE/ADDITIONUSE: eck 2 KIZ <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) C2. <br /> BUILDING CONTRACTOR: <br /> Z <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE �. <br /> NORTH(N). N O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO nl <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. 0 <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN m w <br /> NEEDED. �]\! <br /> I <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 `r <br /> ISSUANCE. �� q <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 /> SETBA K A EA. <br /> 5. kY <br /> %- <br /> (�(� m 0 WZ (0 m <br /> 6. m 3amx . mom <br /> a mCy <br /> R <br /> m o ; o <br /> 7. o Tom : m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my i : rn <br /> —(n `Ci ' C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ma 2 <br /> PP (including Yaccompanying ) g m <br /> all information contained in this application Includin an schedule and I further declare that I recognize _ ^^ m m <br /> �V� <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rr-_ <br /> W i <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to per"county officials charged with administering county ordinances or other ? o <br /> authorized person jo have acqps to the ab described remises at any reasonable time for the purpose of inspection. m m o <br /> _ZS _ 0 m m : <br /> SIGN HERE lve ' E f <br /> (signs of owner or b contractor) (date) ` n <br /> ZONING ADMINISTRATOR : <br /> NCLA o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ���,�U*HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />