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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 o° o <br /> APPLICATION FOR LAND USE PERMITS 3. w <br /> y O <br /> N <br /> C <br /> N <br /> 1 OWNER �19y," /lPj ell A, TELEPHONE o <br /> J/ter D O <br /> MAILING ADDRESSV <br /> �& / C l�c�t9�- <br /> y V r <br /> PROPERTYADDRESS 1 0 <br /> LEGAL DESCRIPTION(see tax receipt) ` CJ00 1-41 / �e%� /V 67 /e7 11IZg 0 m J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION V /O p/yJP W <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> �,{ 0 <br /> STRUCTUREIADDITIONUSE: fn�✓'cbn'1 ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> y7 � <br /> BUILDING CONTRACTOR: NW;T- j /.A 4Zdf A.h d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> T � Z 1� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <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. ° <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. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS U� 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. £ N <br /> o � t <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° w <br /> NEEDED. N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I CA <br /> CONDITIONS OF PERMIT: / <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� O <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 e <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> W n 0 O a 0 M <br /> 6. m sa nm x <br /> v om <br /> Z c m o 1 <br /> 7. o m r'< : m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> P ( 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 n » : I <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize c m0 <br /> that this information 1 am providing will be relied upon b the Count of Burnett Wisconsin in determining whether to is- <br /> P 9 P Y Y 9 W 0 <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 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 the above described premises at any reasonable time for the purpose of inspection. m n <br /> SIGN HERE <br /> (signature of owner or building.contractor) (date) 0 [ <br /> f C I /� <br /> ZONING ADMINISTRATOR 1 l a t ' E ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED C o o u v v o <br /> THIS PERMIT SHALL EXPIRE ONS YEAR FROM DATE <br /> DA E OF ISSUANPE <br /> e44r � tik � to-)d <br /> v64-0b <br /> 1. - <br /> 1 <br />