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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M 0 0 <br /> APPLICATION FOR LAND USE PERMITS -. <br /> N ° _o <br /> N <br /> ` / <br /> OWNERn/jy �r�QI�. TELEPHONE <br /> O <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS AnSc orh Z a t //Ct i1i!i.�R-(-1 1 <br /> W e <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (�, <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION El5 <br /> E] _ <br /> ��Al(S f0 /Gt o <br /> STRUCTURE/ADDITION USE: ' <br /> Home/Cabin; Commercial s� s; Bedroom; Deck, etc.) <br /> ( �� �� N2. <br /> BUILDING CONTRACTOR: <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 -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) OT o. <br /> n p Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m e W A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rrt <br /> CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS f ` <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � <br /> 0 <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. <br /> CONDITIONS OF PERMIT: <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 N <br /> SETBACK AREA. <br /> 5. Mm w ooMDa : m <br /> m x3 'arn Fnm ,y <br /> 6. o o m c y o 3 <br /> Z c y o <br /> o <br /> 7. m its :� M m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0j 2 - C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of rzji� <br /> m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m 0 <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 t CD <br /> j <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T n <br /> m <br /> m a ' <br /> ' o ; <br /> (signature of owner or building contractor) ate) <br /> ZONING ADMINISTRATOR 66n 6q'6' <br /> 8-1 'bT N 01 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �m +�'le+4er-P r- 'W bV 9Ku�f Eas-�o� <br />