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Burnett County 7410 Co.Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator 'D O Z <br /> APPLICATION FOR LAND USE PERMITS . _ <br /> N <br /> N <br /> OWNER (�/V I 'S M 1 j�„ TELEPHONE 2 6 3 - 3 8 I - 0330 <br /> M <br /> MAILING ADDRESS � /b d 1 /.Z U�Al N Sr A N ) Ov C(N r t I /� s S 3 0 y <br /> PROPERTY ADDRESS 2 d 1 y 0 LAJ C S r/— CII U W F b G / I Urd $c/ g 3 o <br /> Umar o�- NE IT4 L4- T>"- (�� � o � T,c Nw I/�I .9'C Rc r <br /> LEGAL DESCRIPTION(see tax receipt) S f= I/�( <br /> I (, W c S rp oak IS N <br /> �-y OBJ I`A� <br /> TYPE OF PERMIT(S): LOJ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE-2- ADDITION El <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: S'7y r n cj G n <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: <br /> Z � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8tk X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. *n ar <br /> M c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Im <br /> U) 03 <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 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. e <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN m g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <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 <br /> SETBACK AREA. <br /> 5. <br /> 10 <br /> 6. m m C a f m <br /> m 3am � °:m M <br /> 7. Z a 0 0 3 too <br /> O St's <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my y D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of mI En C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m r : 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. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m i <br /> authorized persoq to have access to the above described premises at any reasonable time for the purpose of inspection. m s'; <br /> l` m o <br /> SIGN HERE ' 7 <br /> En m <br /> (signature of <br /> owner or building contractor) (date) '• o. <br /> ZONING ADMINISTRATOR \J ) m clan IcL �) E <br /> 1333 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ( N o 0 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />