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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 <br /> y O <br /> C <br /> OWNERG Ir - C f �� TELEPHONE <br /> MAILING ADDRESS f/t�2 S N -I Lf / �]�iV/ G^4&{e lel / l/�! O <br /> r m <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) rJT 3 gfs/vA v 5 y </71! �C, LL' TI d m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1r-1 co <br /> TYPE OF PERMIT(S): c ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N �- <br /> STRUCTURE/ADDITION USE: M <br /> (Home/Cabin;Commercial Business; Bedroom;peck;etc.) <br /> BUILDING CONTRACTOR: C ✓G/ C A /I'7 e t eA ir/ y <br /> 4 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n U <br /> m <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). N o <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. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O 7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BED NE WHEN m o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <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. /j <br /> 5./'�p� --(fir CJ- m� m o Q R�1 <br /> 6.b� �) m 3 a mo xw D <br /> 7. <br /> I declare that this application (including an accompanyingschedule has been examined b me and to best of m <br /> PP ( 9 Y ) Y Y G) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail a d accuracy of w2, <br /> 2 : v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem$ o 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Q m <br /> sue a permit. I further accept all liability which may be a result of the Coun of Burnett relying on this information I am ` m E <br /> providing in this application. 1 agree to permit county officials char l or nces or other o <br /> authorized person to have access to th above des ribed premise r se f i speetion. m m c <br /> CD m <br /> SIGN HERE <br /> gnatura owner or building contractor y AY C to g 1 a E <br /> J Q E E <br /> ZONING ADMI STRATOR <br /> O <br /> / <br /> � T COUNTV��Os r�di N fel,N N O O <br /> l lQ(� TOWNSHIP PERMITS MAY BE REO WIG I <br /> 0l-(Wf S�THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />