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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c) Z <br /> APPLICATION FOR LAND USE PERMITS <br /> _ r <br /> T 0 <br /> m _ <br /> OWNER t �'(/'/� -.1 '�J 1 ' TELEPHONE 6 sem— y 7 7' 2 , <br /> LLL TTT m <br /> MAILING ADDRESS `p 5 S Z/9S T �� C [ L/` ,` 1vr/n�► CD <br /> O <br /> PROPERTYADDRESS o <br /> SA opN r 2 , CA,) _do <br /> LEGAL DESCRIPTION(see tax receipt) ) � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION rn o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT 11SUBDIVISION ❑ a <br /> �/ r7 <_ <br /> STRUCTURE/ADDITION USE: l� r'tC`f>F/y ; I V d K 0 a rY-% o <br /> (Home/Cabin; Comm rcial Business; Bedroom; Deck; etc.) Cn h <br /> a)2. <br /> J <br /> BUILDING CONTRACTOR: <br /> m , <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 ( ,1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n W A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 (n 0 <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. o <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 PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> f 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 w <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. I O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;6. Mr D O a 0 M <br /> p m C y �n o 3 <br /> 7. Z c rn o -� <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — O <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of v n u <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J: m ' m <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 co nIt ordinances or of D <br /> authorized person ss t <br /> have acc o the above desc 'bed premises at any reasonable ti iFP?Sn m <br /> - <br /> ` DE <br /> SIGN HERECL C�l a <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR MAY 2 6 20(15 <br /> v J va i in <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> BURNETT COUNTY C, o o o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM PAT qF ISSUA42NING Cl/ <br />