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Burnett County 7410 Co. Rd. K,No.102,Siren,W154872 Office of Zoning Administrator - Q o <br /> APPLICATION FOR LAND USE PERMITS . <br /> y O <br /> CD <br /> N � <br /> _ n <br /> OWNER �U(l+�es 0 f-Q A'5 6 V\' TELEPHONE v <br /> MAILING ADDRESS Cox q 33CD <br /> PROPERTY ADDRESS I W J E &,z `r We Q Dr, 0'e r- � ) t?-l3 <br /> s . y/r3q ( iot — '_ <br /> LEGAL DESCRIPTION(see tax receipt) 1J:� 1W 9oJ tot m <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ to O <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> N <br /> STRUCTURE/ADDITIONOSE: I C4h ' to / V��)C 0 <br /> I C (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: Se f 7 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p y <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <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 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 I O <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 QO <br /> MUST BE SIGNED AND DATED BY THE OWNER. c 0 ) <br /> 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> t�� <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. `lam\JI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. m 0 r' > o f T <br /> 6. m <br /> a (D C y v O <br /> Z y o ' o <br /> 7. <br /> �CnE <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my A <br /> (�, . 6 c C <br /> U� <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Y E w 0 : En <br /> a^ : u <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �) : m m o mo <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. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am i : m i <br /> providing in this application. I agr to permit county officials charged with administering county ordinances or other (n <br /> authorizedauthorized person tqiiave access the above described premises at any reasonable time for the purpose of inspection. o <br /> �1 m m <br /> SIGN HERE �"' '� o / d' a <br /> (81Z!-!)::f owner or building! tractor) (bate) <br /> ZONING ADMINISTRATOR <br /> JYt.UL` }]J u o v Ln o 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �J Pho <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />