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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 5 o <br /> N <br /> J� y— �j T /J p '7 C <br /> OWNER �� C T"/ � 1 G P CT/l' �76(,U TELEPHONE IS—r7�j Ei—-'71 p <br /> MAILING ADDRESS O� e f- S c1 3 f l= w e h.slew w � <br /> 0 <br /> PROPERTY ADDRESS aY/s'a C JS/ ,e F 14 Q t— Lls I <br /> LEGAL DESCRIPTION(see tax receipt) 6OV(7E . W 1 - t m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ®JJ ADDITION ❑ (n <br /> TYPE OF PERMIT(S): C ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °' <br /> STRUCTURE/ADDITION USE: �p I � r3 G r nJ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Q <br /> m <br /> BUILDING CONTRACTOR: m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 <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 r <br /> BUILDINGS,ROADS, LAKE, LOT LINES. V f <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1 <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. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Oa <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> aoM >0 > <br /> CD C6. m x6 am xn D <br /> p N C y y 0 = 3 <br /> 7. Z c m 0 O -{ <br /> o : -n� : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — cn : : O <br /> PP ( 9 Y ) Y Y [j - C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m �_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C) <br /> :7 <br /> sue a permit. I further accept all liability which may be a result of the County or Burnett r9n this,information I am : a : o <br /> providing in this application. I agree to permit county officials charg I a it t� IVthVjtro!D <br /> b4 inances or other m <br /> authorized pe on to have access to the above described premises t o e i of inspection. <br /> T O- <br /> N n <br /> SIGN HERE Q to [ n <br /> (signature of owner or building contractor) 2 (date) <br /> i <br /> ZONING ADMINISTRATOR <br /> IS NIr I EA di EA 1.9Q N <br /> �'�� ONOI W W NO <br /> O U O OI ( 0 O <br /> TOWNSHIP PERMITS MAY BE REQUI <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />