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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O» <br /> N <br /> C _ <br /> N <br /> ppe per/ 0 v t� <br /> OWNER I7/I/JO/A'®I T /IL1 TELEPHONE 9sr�� /�_/CL�� d AO <br /> O <br /> MAILING ADDRESS / <br /> 041 <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) Q� ��� Cn <br /> A L, to'✓ 7-• 691 <br /> `� m <br /> i 1 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C ° <br /> TYPE OF PERMIT(S): a ° <br /> FILLING/GR DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ /, <br /> N <br /> STRUCTURE/ADDITIONOSE: - ui/A �.�j l�f� /1�i�A�l/f �P41A91�t s �P� ° <br /> (Home/Cabin,Commercial Bus'esd,Bedroom,De&;etc.) d <br /> BUILDING CONTRACTOR: � �///Ao DZA& G. m <br /> 2 <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p 'F <br /> M W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O M <br /> n <br /> ?r O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> c <br /> ID <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF O 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° QJ <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> � o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 1 <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 1� <br /> PERMITTED. " 1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA <br /> $ 3 'am xa <br /> vv <br /> "Ob cN <br /> Z H O O D <br /> 7. in : I� <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mt7 <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 d <br /> providing in this application. agree to permit county officials charged with administering countyordin <br /> authorized person to have acce t above described premises at any reasonable time o : <br /> m : <br /> d : <br /> SIGN HERE <br /> ure o ffier or buildractor) ,r/ � � n OCfatte) <br /> 20 <br /> ZONING ADMINISTRATOR Q/7 <br /> NC `" <br /> BUQIlliTT COUNTY N`00`(T (nn N N O <br /> GG v � cT [nO 0N0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> mai I-ed -to fad wftV[t, ted /o —lis—b3 <br />