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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator TO c) Z <br /> APPLICATION FOR LAND USE PERMITS g. = P <br /> C4 <br /> OWNER , /�/ rn TELEPHONE <br /> J m 2 <br /> MAILINGADDRESS SS L � �C/(.F �O <br /> r � <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION � (, U'( -S — O (n o <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> �n-a,�,,,, f <br /> STRUCTURE/ADDITION USE: SfLJ l ll I(J� I 00m 0 <br /> //nom n (Home/Cabi Commm rci �Business; Bedroo�/T}A Dpck; etc.) 2. <br /> cn <br /> BUILDING CONTRACTOR: lYX/�I./CL./:YLL!\ (g-7L p I 1-��l(�l Cr <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> z C, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n M A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m E <br /> NORTH(N). (a '� 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO (I� <br /> BUILDINGS, ROADS, LAKE, LOT LINES. (y <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 ) 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F t <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0, <br /> NEEDED. C� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <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 UO O, <br /> PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m a W m 0 M a * m <br /> 6. 3 <br /> o > > n o o, N <br /> m Fnmx _ .L <br /> N C y y O J <br /> 7. 3 <br /> Z C ,^j, A O U] <br /> O m Tr .ZI <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - O <br /> PP (� 9 Y ) Y Y ' G) <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m $ o <br /> ms ' <br /> that this inforI am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- M ` m <br /> sue a permit. 1 urt r accept all liability which may be a result of the County of Burnett relying on this information I am d I o <br /> providing in Is ap IicaY r_-1 o ermit county officials charged with administering county ordinances or other <br /> authorized p on ac s to above described premises at any reasonable time for the purpose of inspection. m a <br /> T <br /> SIGN HERE 12 O ' O S . n <br /> v n : <br /> gptur of owner or building contractor) (date) J <br /> ZONING ADMINISTRATOR �J t m �G.n LC161 h <br /> fA 6i fA fA N <br /> O N (T W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N O u N T O <br /> TH ERMIT$HALL EXPIONE YEAR FROM DATE F ISSUANCE <br /> l�-,,er P'6te-d uP gy 17w'l 41?h ❑ft i1;1 6g 65 <br />