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Burnett County 7410 Co.Rd. K,No. 102,Siren,W�I 54872 Office of Zoning Administrator -0o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER- r/ V /�/�� Y�(I.tZSC/ 4 YN t (I� TELEPHONE 6 q —0 z6 <br /> MAILING ADDRESS 76 24C , f7/TW 14/1/6E R J� (N E3 Sl En ICU T ' <br /> ° m <br /> PROPERTY ADDRESS l p L )r n 1 <br /> LEGAL DESCRIPTION(see tax receip / A (�f <br /> t) V I // <br /> �/� � o <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ d`1-�–� �,�j c <br /> TYPE OF PERMIT(S): a_ <br /> FILLING/GRADING ❑ CAMPING UNIT l SUBDIVISION ❑ �o ado Z' <br /> STRUCTURE/ADDITION USE: //[ r (1 Q <br /> (Home/Cabin; mmercial Business; Bedroom; Deck; etc.) w <br /> 2. <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR A <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y C <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. m m p �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C � 3 <br /> NORTH(N). <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 ,1 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <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 /> S. 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 O �. C <br /> MUST BE SIGNED AND DATED BY THE OWNER. JZ'v 7 Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN H ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT g,J a <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C!5 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. v mywm � 'o � <br /> 7. cH W O0 <br /> Tom : i i m <br /> =WE A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 6, : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a.cam. N ra <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- (D <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 `• E E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso have access a above described premises at any reasonable time for the purpose of inspection. T m o <br /> m i i ip i <br /> SIGN HERE "` / 'a <br /> I tura of owner o ullding contractor) (date) <br /> qd <br /> ZONING/ADMINISTRATOR �h 1� E <br /> L1 ^^/1 )_ / N 0 ra O O <br /> -vFCIA�e// bA`-� ul <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> /1. c� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 315C� <br />