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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> ^" r <br /> y O <br /> N <br /> OWNER . St? TELEP�HONE w e Ga <br /> MAILING ADDRESS 6 33 C Ou h 44-fZoo � a,0 4i2a ° <br /> PROPERTY ADDRESS <br /> n <br /> LEGAL DESCRIPTION(see tax receipt),j 6 7wpya 2 J/ ,,13 aH <br /> DWELLING/BUILDING L� GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ •rn 5 <br /> TYPE OF PERMIT(S): ❑ v ° <br /> FILLIN_G/GRA ❑ UNIT ❑ SUDIVISIO�I / L a <br /> STRUCTURE/ADDITION USE: / 0 LOu <br /> r /J�/71 0 `> <br /> Ho /Cabin; ommer ial Business; Bedroom; Deck; etc. <br /> BUILDING CONTRACTOR: rl 7 4 O/lJ y <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR ° <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m a <br /> ?� T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m v j3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C a; <br /> O <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 1 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ; o <br /> If <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. C-�j <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. --1 �O <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA� � g <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. U�NE�CO G � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Zo vllvd+ �N <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 /> ftp// 4 m 01- > 0 > 0106. S a � amx ° m � <br /> � N C y y 0 7 T+ <br /> 7. Z w m ° '• ' ° <br /> ° n 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 <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° m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person have access to the above described premises at y r sonable time forthepurpose of inspection. : s, o <br /> / <br /> SIGN HERE 4 - ;7 7- 4 <br /> m <br /> (signature of owner or building contractor) (date) a <br /> ZONING ADMINISTRATOR im <br /> -�l �NN <br /> u o o� o <br /> S'GUL TOWNSHIP PERMITS MAY BE REQUIRED LrJ \ <br /> j`THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 't <br />