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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator mC Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> C'c2� 9Sz— 3 N r <br /> JOHnJ C, �/ / ar a w <br /> OWNER r �- Jam/ �C--.L�2 TELEPHONE O '� <br /> o <br /> / CDO <br /> MAILING ADDRESS Gj N, 0141— cr Sr <br /> PROPERTY ADDRESS rr()Q� /41 z (1v <br /> /p�� C CA yl <br /> LEGAL DESCRIPTION(see tax receipt) (D r z 6e�? <br /> N�(�' n <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE' <br /> XADDITION.t'V U) o <br /> TYPE OF PERMIT(S): FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n J <br /> STRUCTURE/ADDITION USE: S1-U2A6 o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> TfFo.�-t�1 S <br /> BUILDING CONTRACTOR: 1�14UC6' <br /> w <br /> a <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SYS X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. O o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO G <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N CYC <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 r <br /> MUST BE SIGNED AND DATED BY THE OWNER. a W <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> n <br /> NN <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z ) <br /> CONDITIONS OF PERMIT: ° <br /> OnI <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 ALO NQH L r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFr ; <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHk)THE REQUIRED WATER L <br /> SETBACK AREA. <br /> 5. GRrr,Ll5p A,jd, <br /> W n r D O D O M <br /> s. m cmm0 maf MP, zOUNTY � X� aNNa ° A <br /> 0 ID 0' � 3 <br /> 7. td.7t�;lNG z y o <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my ;' JO <br /> PP ( 9 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 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �I m C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p Cn <br /> 7 O : <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 0 o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m_ '• <br /> D <br /> authorized person to hav ess o the above described premises at any reasonable time for the purpose of inspection. CD <br /> T d <br /> d <br /> SIGN HERE <br /> (sign u e of owns r ilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> 69 S4169 K) <br /> O N O UWl (WJ I N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />