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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> ,�J // ' / m o <br /> OWNER ��HTS /�1 H%t�s�LEPHONE <br /> d <br /> MAILING ADDRESS3,?SU / / sr T7 �/f�/ <br /> 4 c �z. } Sso75 <br /> /� / <br /> PROPERTY ADDRESS /y33 SS/t 2 /!oC o U F 4J <br /> LEGAL DESCRIPTION(see tax receipt) rn <br /> � <br /> S{r c 2 'moo�., r.l.e 5/0,�4 nqr 7 �1 � 8<r rn r/7` � �• <br /> DWELLING/BUILDING Ipj GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ (n <br /> TYPE OF PERMIT(S): <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N <br /> STRUCTURE/ADDITION USE: 24�3 m s /tea.h /'n e��;79 Ocejt/ / (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: rT v 11-Ar /Y u 1- L� C m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> 0 m <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 m d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 0 <br /> I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 1 9 C3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFj <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. OQ 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o a <br /> NOTE: BUILDINGISTRUCTURE 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. ° Z "1C <br /> CONDITIONS OF PERMIT: 0 1 <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. �D <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 /> coy io rDi 0n0 m <br /> 6. m x3 am sa ' ;u <br /> O p W C y N O7. 7 3 <br /> Z C y O ; 1 <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 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm n N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 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- <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 county ordinances or other ,o <br /> authorized person to have ac o the above described premises at any reasonable time for the purpose of inspection. `0 n <br /> T : <br /> m > : <br /> SIGN HERE C <br /> (signature ner or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR hIY\ ill <br /> �fA bi ER fA� N <br /> O N U f W W N O <br /> O (TOtI. Ut (PO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />