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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 2- In <br /> P�• '"'X 3� a -Z <br /> OWNER 4L o4"17 Ot1S�'s[ i TELEPHONE <br /> (D 0 <br /> / m <br /> MAILING ADDRESS S �y3 tt FaY `-�' <br /> • II / o <br /> PROPERTY ADDRESS /4+ ��r h R N h U v v W J Yg3 C1 " <br /> \ <br /> LEGAL DESCRIPTION(see tax receipt) ,,V 5— i-I© <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION'O O U) <br /> TYPE OF PERMIT(S): C n <br /> FILLING/GRADING EJ CAMPING UNIT ❑ SUBDIVISION ❑ < ,S <br /> �t �t N �3 <br /> STRUCTURE/ADDITION USE: o2y�rC 0. 7L/, l?4recfwyp e_L s ���C S� /a�eYoZO ° <br /> (Hom abin;Commercial Business; Bedroom; Deck;etc.) w <br /> �( 2 <br /> BUILDING CONTRACTOR: ave <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p N rZ 4 <br /> .G N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Q <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m� D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N g j <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS ?. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t.�) <br /> ISSUANCE. t <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. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ��j�'' <br /> r V�l I a�X�'— I/'CUL X o rr-i CO,D0 a f m <br /> 6. v (D 3a2a � '� <br /> O O <br /> 7. p y N T ' M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —2 ' A <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 ` ) w o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> s <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- �lE <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 ; ro <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m v,o : <br /> CD m : <br /> SIGN HERE :1 fLo En <br /> (sign of owner or buil I g contractor) (date) a <br /> ZONING ADMINISTRATOR �p <br /> y, EA <br /> N 0 Cn �NO <br /> (60'.� I�y�' v TOSHIP PERMITS MAY BE REQUIRED u <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />