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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> C .r <br /> j� TELEPHONE / -7 U m W <br /> OWNERet-clor✓ / lW1i(Qt� (PS'-�_37 S-02.L <br /> MAILINGADDRESSCD <br /> r <br /> PROPERTY ADDRESS o <br /> �� t-1 �ha s4 e Q <br /> Pl f� W A <br /> LEGAL DESCRIPTION(see tax receipt) �Cc 7-/gyp /7�•v a�Y ����/�] 16 <br /> DWELLING/BUILDING 9 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 O .� � o <br /> TYPE OF PERMIT(S): r 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: ti <br /> c ( ome/Cabin• ommercial Business; Bedroom; Deck;etc.) to ' <br /> BUILDING CONTRACTOR: <br /> iv <br /> Q <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) y <br /> O `I) <br /> 'fl c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> O Z <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 In <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 <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. <br /> ,p 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 /> CONDITIONS OF PERMIT: 0 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Fy n <br /> ISSUANCE. S <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 /> 6.5. (insi{ , -as-0y <br /> w <br /> = � a <br /> F m <br /> CL m 3m �c :;1DM <br /> 7. m C y y O j 3 <br /> Z N m O <O <br /> T� 33 <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my 21 � O <br /> G) i <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including an accompanyingschedule a c <br /> PP ( 9 Y } N?r-declare pt Frecognize m m <br /> that this information 1 am providing will be relied upon by the County of Burns tt VNi n+lh Ide�erml� hetNer to is- ° m E �2 <br /> sue a permit. I further accept all liability which may be a result of the Coun <br /> providing s or thi f rmation,I am m <br /> p g in this application. I agree to permit county officials charged with inistering county ordinances r other m <br /> authorized person to have access to the above described premises at any reas le time for the purpose of Ins action. m <br /> It <br /> SIGN HERE .� m m <br /> C . <br /> (signature of owner or building contractor) `3URNETT Wt"TY o. <br /> ZONING ADMINISTRATOR I/ <br /> TOWNSHIP PERMITS MAY BE REQUIRED N(00 lI�!g o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE I V) <br />