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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N � <br /> N rn� <br /> OWNER I GK .I �� L �f2 hj4 ,CZG I�IrI TELEPHONE <br /> li c. l_ <br /> MAILINGADDRESS h(Q 7U Rot,eJ A C (� 1 C4 v6�e/ \ tS v O <br /> A 1\ [L W <br /> PROPERTY ADDRESS '�R I?ay Q 5 Al O t)y ( 1 <br /> •'✓ (� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 1V L 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> /1 r <br /> STRUCTURE/ADDITION USE: II$t3 51 � Q WI(W � ,�'6 fj �' 0 <br /> _{.. (Hom/e/Cabml; Com ercial Busines Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: �Q/ 1 �i('�� ClQ It/'St GD �j � rI <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 3 <br /> O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) MO <br /> T G <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o A <br /> m m <br /> NORTH(N). C ct <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <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. t z <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. ALJ <br /> 5. 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 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,A <br /> o f v 1 <br /> o (� <br /> NOTE: NGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> NEEDED. <br /> n03 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <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. <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. ea�i i\ t�, IJV/ x W y d > O D o -0 <br /> a <br /> F m <br /> mm 3 a m 0 a <br /> "o pm Cy ." o � <br /> 7. Z c m o <br /> N T`G ;I <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. 1 acknowledge that I am responsible for the detail and accuracy of m rte, c <br /> all information contained in this application(including any accompanying schedule)and I <br /> her declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i <br /> O : z : <br /> sue a permit. 1 furt er accept all liability which may be a result of the County of Burnett relying on this information I am o <br /> providing in this a ation. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to a access to the above described premises at any reasonable time for the purpose of inspection. <br /> n <br /> SIGN HERE � na <br /> (signature of owner or building contractor) (date) I I o <br /> �7 <br /> ZONING ADMINISTRATOR JI71an <br /> 1J ON (Nl, <br /> TOWNSHIP PERMITS MAY BE REQUIRED (lly <br /> OM NO <br /> THIS PERMIT SHALL EXPIRE O1 EAR FROM DATE OF ISSUANCE <br /> 70Ef/nri 6ely\T -ro /' sin �(j�15� 6,-lb-6.1 <br />