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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> rn 0 <br /> OWNER TELEPHONE I - 0 31 a] n <br /> _ l <br /> MAILING ADDRESS �IVG�fuQ /11n1.1fVYlI fn <br /> ��► JAS(�Ci o m <br /> PROPERTY ADDRESS PROPERTY ADDRESS l��PJ'(e ��� eA <br /> ( p) L o+ $, 17-�nn5 � nt E LR ka <br /> LEGAL DESCRIPTION see tax receipt) cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ I '. <br /> � N o <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING CAMPING UNITBDIVI ON ❑ n <br /> rn <br /> STRUCTURE/ADDITION USE: IPM14 0 <br /> '(T'elCo mercial usiness; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: iu <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. T f , <br /> y W <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. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). y 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m .o <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. Q j <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. o o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o G <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P �_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q� <br /> ISSUANCE. �. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE1 k I y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICAL)Y-�:j r <br /> PERMITTED. I` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THEF�EQUIREDW ATER m <br /> SETBACK AREA. <br /> 5. J{ AI'R <br /> BU dwrDi � a � m <br /> 6. RNE i r (" 3 nmO c�) nm ;U <br /> ®Iu L "O (gyp C N y O 3 <br /> �. ZOIVIN� N Z y Co. 0 <br /> ;D <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m 0 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 a a) <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person have access se the above described Ises at any reasonable time for the purpose of inspection, m <br /> -n o <br /> a � <br /> CD <br /> SIGN HERE141 17 <br /> (signature of owner or building contrac ) ) n <br /> qj <br /> ZONING ADMINISTRATOR <br /> : <br /> EA fA ffl EA to N <br /> N (T N N O O <br /> (TO (n (n00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />