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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator71 o° o <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 <br /> 00 <br /> OWNER 8p II $$ Qs' TELEPHONE 53 ?a v = C7 <br /> MAILINGADDRESS P �� �� �/ � � ��, 99 <br /> e Y-� r � <br /> PROPERTYADDRESS ®e� Z4 le-104.v �9Y% ��� G® O <br /> Or- � �(A,C1 /J 0j�j <br /> LEGAL DESCRIPTION(see tax receipt) gA 4 � �� \ <br /> DWELLING/BUILDING Lei GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn O <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING CAMPING UNIT 1:1 SUBDIVISION Eln <br /> STRUCTURE/ADDITION USE: 6 (Ho <br /> s <br /> (HomelCabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: 'r � d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a 4 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> ct <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 d ) <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 t <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Nt <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS t �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. •, <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O 9, ) <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �r <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O � <br /> ISSUANCE. R� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Y t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY /'�"� <br /> PERMITTED. W rO� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V <br /> SETBACK AREA. <br /> 5. <br /> mC N N 0 N o. f m <br /> 6. m F3D00 a �= A <br /> a o m cy .`" 053 <br /> Z m m o <br /> 7. m <br /> 1 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 [ � C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of : <br /> u <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize i m $ [ M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,p i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N 4 : <br /> SIGN HERE aE <br /> (si a re of own building contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> O N [T W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O W <br /> THIS P RMIT SHALL 9XPIRE ONE YEAR FROM DATE OF ISSU/IyNCE J^ _b <br /> "(n1 ' 4- e4-Kr 0-V t lQ�i �y W 17l(llir ► i scl-u dy1 <br />