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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 /> r <br /> N <br /> C <br /> N <br /> OWNER TELEPHONE / \ <br /> 1��� ) �oAL <br /> .ZS'1c.�7f�� 0 <br /> MAILINGADDRESS -7 n <br /> O <br /> 1..��LT <br /> PROPERTY ADDRESS ���7g -S�J l lF!'l �u�l{ r ��2 n bC�YY 7Y Vf)I <br /> LEGAL DESCRIPTION(see tax receipt) VV <br /> N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESS RY STRUCTURE I ADDITION ❑ rn <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n C <br /> A/ <br /> STRUCTURE/ADDITION USE: /trete (�Tlf✓4 E �C[<) PC K n <br /> c+ 4J�5�S�Cf'1 .� rr <br /> (Home/C tn; Com ercial Business; Bedroom; Deck; etc.) o lhiSe_ m r <br /> m <br /> BUILDINGCONTRACTOR: T thYr(S f5 Z�7t5 .vim <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 S EET OF PAPER. ANY INCOMPLETE OR 3 �r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n _ T <br /> '`' ANG r <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O n <br /> II T CC <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOW 4 OR DRAWN TO SCALE. () m C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDI GS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO cn Q '� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT T THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLA D AREAS. t o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(Sly)AND DRAINFIELD(DF),AND ALL DISTANCES TO e— <br /> BUILDINGS, ROADS, LAKE, LOT LINES. O <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. o t <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKEDSO AN ONSITE VERIFICATION MAYBE DONE WHEN c q F <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTE WITHIN 60 DAYS OF PERMIT 0 <br /> ISSUANCE. � O 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RE TRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWE D UNLESS SPECIFICALLY <br /> PERMITTED. U, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,AL OWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> �7 mOr D OD O 'D <br /> m c m m m m � F m <br /> 6. '', m n 3nm xam .� <br /> ',. <br /> 0- 2 cz y y J 3 <br /> 7. Z C N m O t0 <br /> o m T`< : m <br /> I declare that this application (including an accompanyingsch Jule has been examined b me and to the best of m y 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 n <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 Cc unty of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result if 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 <br /> authorized person to have access-to taboviLdesc 'bed premises at any reasonable time for the purpose of inspection. <br /> T n <br /> r —.. ✓. <br /> > : <br /> SIGN HERE <br /> (si nattu4e of�owner <br /> �or building contractor) (date) i [ <br /> ZONING ADMINISTRATOR UI t d 1� I pr- ( ar) (C�� <br /> �/ �fAM63 fA�N <br /> a O N O N N UNi O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> T,tIIIS PERMIT SALL EXPIRE ONE YEAR FROM DATE OF ISSUA E <br />