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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> U o <br /> OWNER TELEPHONEl3 <br /> m <br /> MAILINGADDR7 G ESS / LI / Llid fa J /�0 , rn IV `j Sa3$ ° <br /> a� 0 <br /> PROPERTYADDRESS '"� /Y�,nJG��� �,y�IY RJ , ( V �I r <br /> LEGAL DESCRIPTION(see tax receipt) L=-;� C SS�-n 34"'y o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn ° <br /> TYPE OF PERMIT(S): c ' <br /> FILLING/GRADING 1:1CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USE: 46 x C ,5 E0e-O-� ' S ke4) „ <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) Cn <br /> W <br /> BUILDING CONTRACTOR: 2. <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m QJ <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF T Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I ° <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o � � <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 /> V.,W I <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> TBACK AREA. <br /> 5. 9 �/ //� y� <br /> IV�(l�/1/ GQ � 16 /T�(A71 Ef rlei z WID W 01 <br /> 01 D o D M <br /> O a mcN �' o � 3 <br /> 7. Z N o ,o <br /> o T ;U <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person topave ccess to the above described premises at any reasonable time for the purpose of inspection. `D o <br /> -�s--� <br /> CD <br /> SIGN HERE <br /> a : <br /> (signature of o r or i (date) <br /> ZONING ADMINISTRATOR D ;ZD 197-1 <br /> w to <br /> Vi VA fA d!� N <br /> N L"N N N 0 0 <br /> 0(71 0 (T Cn 0 0 <br /> TOW SHIP PERMITS MAY BE REQUIRED ivy( <br />