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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> f/! <br /> C <br /> (D <br /> / _ p n �y <br /> OWNER LJ t�i�r� �� �� TELEPHONE 6,g'/-228'' <br /> �[ � f O <br /> MAILINGADDRESS /HA/ 1 <br /> o � <br /> PROPERTY ADDRESS 1 f' $e GS£,&ad JV <br /> LEGAL DESCRIPTION(see tax receipt) Cpe �La7 �-3 <br /> m <br /> DWELLING/BUILDING © GARAGBACCESSORY STRUCTURE ❑ ADDITION ❑ c <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> N <br /> STRUCTURE/ADDITION USE: � L <br /> k wA&4f <br /> (Home/Cabin, Commercial Business; Bedroom, Deck, etc.) m <br /> mel i <br /> BUILDING CONTRACTOR: � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 FIT <br /> ~ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <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 C o <br /> to <br /> NORTH <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDINGS)TO m 30 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Q <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 PLANSI n °. <br /> MUST BE SIGNED AND DATED BY THE OWNER. (J ) o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> Z lJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <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 <br /> NOsrRU TURES, ��INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACKARE <br /> 5. NO eycau&-*10� Joh MUM— 01v bloQe eXc4,°J1,V L m on 0 m rDi 0 nq: g) <br /> 6. If `fv b t-u ll�( straw bale s,it yG/ GC Vl� In m_ � n m a^ ', omcy ^ o7. 1stc cr &.4 hs,� i- g t 0/v 7d Gvf}r� /� o 0 " -n°= tn : � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) 2 - : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 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 C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 ° <br /> providing in this application. I agree to permit county officials charged with administer n r o m <br /> i cir m � <br /> authorized person have access to above described premises at any reasonable t n <br /> J (D D i <br /> n : <br /> CL ; <br /> SIGN HERE o <br /> gn lure of o er r building contractor) •,4date)' <br /> ZONING ADMINISTRATOR J 1 <br /> BURNETT COUNTY N W W <br /> o � o � � o <br /> TOWNSHIP PERMITS MAY BE REQUIRED �ONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS UANC <br /> Rrmif--+Iet-Fe-r " i leaf -fo 6era Id 5arnP <br />