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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -00 Z <br /> APPLICATION FOR LAND USE PERMITS <br /> ,I a <br /> OWNER TELEPHONE 6Is <br /> MAILING ADDRESS �JrAn t g a M t 1 t j O <br /> PROPERTYADDRESS �Sj 8 �?e e 1 <br /> LEGAL DESCRIPTION(see tax receipt) � j � , / <br /> DWELLING/BUILDING ® GARAGEIACCESSORY STRUCTURE 1:1 ADDITION El <br /> TYPE OF PERMIT(S): c/)i �� 4 a <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION El <br /> «, 4w f" H&eylo- m, Lot- to H. <br /> STRUCTURE/ADDITION USE: S rnrJ,e e <br /> (Ho a/Cabin;Com(dercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: SE t � <br /> Z <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a f+m <br /> :0Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 'D <br /> NORTH(N). <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. o <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. NP <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> jN w <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 i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: ' <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <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 /> �SyETBACK AREA. ` <br /> s.Cqk� l/ Sl�'YLQ d �2 P_¢ 1C Q; ID&rd alLc ��[ e <br /> CD m m g 2 a f m <br /> 6. m 3am �c ': m � <br /> -o (D Cm o <br /> 7. Z y m o c a <br /> o T'� M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ O <br /> PP ( 9 Y ) Y Y G) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of (� ro 0 <br /> 1 a 70 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o�y m $ : Lon : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C: (DG):: <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 <br /> providing in this app0pation. 1 agree to permit county officials charged with administering county ordinances or other �3 o <br /> authorized peo ave access to the ab ve de cribed premises at any reasonable time for the purpose of ins ection. m o <br /> rso <br /> SIGN HERE oY0— <br /> s gna of owner or buSffing contractor) (date) ` n <br /> ZONING ADMINISTRATOR <br /> ��//)� � ��//J/ E en to <br /> 4"t fq ly4//�� �/ ('1 (n 0 fA fA 0 N <br /> /�,,� TOWNSHIP PERMITS MAY BE REQUIRED <br /> 12� THIS PERM T SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />