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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 . <br /> r <br /> y o <br /> OWNER �' 6 C R �` + S 2 TELEPHONE �-�- gG6- l 9 / n <br /> fY ►�� m w <br /> MAILING ADDRESS o! 7loSL6 GA 64-c 5 nd <br /> 11 0 <br /> PROPERTY ADDRESS (5,4b4.(eS rL d ~ <br /> LEGAL DESCRIPTION(see tax receipt) Btocju <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> lkII``'' �. <br /> T <br /> STRUCTURE/ADDITION USE: 1 0 <br /> / (Home/Cabin;Commercial Busi ss; Bedroom; ck; etc.) 2. <br /> m <br /> BUILDING CONTRACTOR: k.,0At--r f1 u kL 5 <br /> v <br /> CO � <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. <br /> p �J , <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> ?t O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO) T 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. UP S6N <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. m <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. U <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> :0 o0r,-) >a > <br /> 6. Ci 3 n$ OR m <br /> m C33 <br /> 7. <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — �' Q <br /> PP (• 9 Y ) Y Y � <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m f cn C <br /> 0. U1 : >1 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> m (c i <br /> SIGN HERE � �` Z f —� � �' E ID E <br /> (signature Kf owner or building contractor) (date) <br /> ZONING ADMINISTRATOR jj� QC� <br /> fA to 69 N <br /> Ln0 ((A OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />