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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -00 Z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> I r- <br /> 0 c 1 <br /> OWNER <br /> &0-44) ZW } TELEPHONE <br /> Gly �6 7 <br /> � a <br /> N <br /> MAILING ADDRESS /114J O <br /> 495� s(,,� may- �7�`��' � <br /> PROPERTY ADDRESS r L f/t # lwl „p f UD T f / ��-S J r a / l t <br /> L*4 17 J \ � <br /> LEGAL DESCRIPTION(see tax receipt) / / ^ <br /> - w� �/y �n 07 7btJjiMrt�31ryk#p y/ N e F ,� � �s� CO <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE X ADDITION ❑ o <br /> TYPE OF PERMIT(S): c D .+ <br /> FILLING/GR,ADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ G.Cl7►'► . a <br /> <. <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cn; Commercial Business; Bedroom; eck; etc.) <br /> BUILDING CONTRACTOR: �r!Pf' a•a4 / jam 4 �j_- a(�'�3Q1 �,,; �yX�/�r v , <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n A <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O o <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 6 ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �0 <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I <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 O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ° Y <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 --1 1 <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z 1 <br /> CONDITIONS OF PERMIT: ° cam, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. / 'j <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V" <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 4zz- O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. W v � o D O <br /> m <br /> o cy o 3 <br /> 7. Z c rn m o co <br /> N . <br /> P m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of myA <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of i m n c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize 4- m ; M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D to <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 i o0 : o <br /> providing in this ap I' t' I agr a to permit county officials charged with administering county ordinances or other m m <br /> authorized person o have s o the above described premises at any reasonable i <br /> v <br /> T n <br /> 4 <br /> 5D m D : <br /> T <br /> a : <br /> SIGN HERE En Q <br /> signat�re of ow r building contractor) (date) o <br /> ZONING ADMINISTRATOR r r + ` antoanO <br /> d ii E En En <br /> n 0fA Efl WW -� N <br /> (\ NN (J W NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PER IT SHALL EXPIRE ONE YEAR FRgM DATE OF ISSUANZONING <br /> MCCI,teA +b <br />