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Burnett County 7410 Co.Rd. K, No. 102, Siren,Wi 54872 Office of Zoning Administrator M 0 o <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 <br /> rn O <br /> C <br /> TELEPHONE � )OWNER . d <br /> O <br /> MAILINGADDRESS �Jf�J�,I,�nJ/d/�I(�''/ <br /> 1PRg9ERTY ADDRESS .21,9 7 �/ii✓ �/eew✓ i/�fS. Y� -1 V /At qe, o <br /> /' Q J/ <br /> LEGAIESCRIPTION(see tax receipt) Loi5'y Spr,�l(f Greece /7a(�- ya^ [�� m <br /> V G .mow <br /> DWELLING/BUILDING � GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ m <br /> TYPE OF PERMIT(S): or <br /> FILLING/GRADING ❑ CAMP.IINNG. UNIT <br /> ❑/SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: ARraw ale-C/< 0 <br /> po (Home//Cabin; Co/mme ial Business; edroom; Deck; etc) vH m <br /> BUILDING CONTRACTOR: �j'Q/Y L7,i �S�Y" Zq /�G O-OdS �/J9e /J7w.) 51 <br /> O 'S <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) mOa <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> �J <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 Z <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. (1 , <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. OQ <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. f <br /> N IS <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 00 <br /> CONDITIONS OF PERMIT:' O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <br /> ISSUANCE. O 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 0 cc: m d 0 M a F m <br /> 6. m x3 m A <br /> �m (Z ^ o 3 <br /> 7. Z c ti m o <br /> o m : -n. M <br /> = o, m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m �: a <br /> PP (� 9 Y ) Y Y G�� � ; C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m �_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 m O <br /> providing in this application. I agree to permit county officials charged with r o other <br /> authorized person to have access to the above described premises at any re t e r e u 'n tion. ° 'o <br /> m <br /> m <br /> SIGN HERE — Z9— <br /> Cl <br /> `^ <br /> (signature of owner uilding contractor) ^'Otl I rlrfr►'!e) ' 0 <br /> ZONING ADMINISTRATOR 'I VV LLUUVV�g ) <br /> �Fn' vi <br /> BURNETT COUNTY O O N U W WN O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING rn 0 o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 0 <br />