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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> O <br /> OWNER e6r n �G�r f,.q i1 TELEPHONE n <br /> O <br /> n — r/ m <br /> MAILINGADDRESS J t� d �p�JE L�/4� A� O <br /> F� D <br /> ` r m <br /> PROPERTY ADDRESS ) 1 <br /> l /1 <br /> \ (1, <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n ` <br /> /� 0. <br /> STRUCTURE/ADDITIONUSE: l'a/tC 6 cxrs-h�.v af >�C� ��IC(� D 1 <br /> s (Home/Cabin; C/omm ial usiness; Bedroo/ml Deck; etc.) ti <br /> BUILDING CONTRACTOR: / fEY+ -r/C([g/� lG'�1 � J-OC)sa <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> O <br /> Dos,jy <br /> DIRECTIONS FOR PLOT PLAN DRAWING e- CC- <br /> (AERIAL OR TOP VIEW) O <br /> � n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE v p <br /> m m' <br /> NORTH(N). _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B) BUILDING(S)TO m V ,tc� B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF \ �n v Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 93 <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. O o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. y o I <br /> 9 * Ij <br /> NOTE: NGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEED <br /> NEEDED. 0 <br /> ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a I <br /> � <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. 6 <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 /> PERMITTED. p 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 7' <br /> SETBACK AREA. <br /> 5. <br /> 6. m wo0i r Mnv <br /> m x 3 a m Z a m A <br /> 7. 9 p N C y ." O <br /> O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — ^' �+ A <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of [ m n N C <br /> all information contained in this application (including any accompanying schedule)and I <br /> her declare that I recognize a i ! m i 1 ; m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <n <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 ' obi : o' ' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other '• m '^ <br /> authorized person to have a ss to the above described premises at any reasonable time for the purpose of inspection. 0 m <br /> n <br /> SIGN HERE �— <br /> —7 —a 6 m ` D <br /> d <br /> (si nature of owner or building contractor) (date) : . o <br /> ZONING ADMINISTRATOR V rm �`�nV/IC%/Ir� yh✓ j <br /> O N Ut W W N <br /> TOWNSHIP PERMITS MAYBE REQUIRED O <br /> -IHIS PERMIT SHAL4 EXPIRE ONE YEAR FROM DATE F SSU NCE <br />