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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N � <br /> OWNER TELEPHONE <br /> d <br /> MAILINGADDRESS --SOS Y F Ul,� /gr O ;7 <br /> PROPERTYADDRESS 7Z / A4�Fj <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> 2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ 0 <br /> TYPE OF PERMIT(S): ADDITION O <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: G(ri ✓G C� o \ <br /> (� (tlbme/Cabin; Commercial Business; Bedroom; Deck; etc.) En <br /> BUILDING CONTRACTOR: par 0P c ✓\ <br /> Z � <br /> v <br /> m <br /> PLOT PLAN MUST BE PROVIDED LEAST AN 8' X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> /: 0 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, r 2 z <br /> O T <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m {a p <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m `\ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ' 9 <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. g �, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N XJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. S <br /> F ) <br /> O 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. z <br /> CONDITIONS OF PERMIT: <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 'fi� i <br /> ISSUANCE. !!! <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> S TBACK AREA. <br /> 5. I IAfC� v1�S�d/�rLr�e�js-�t�d.al�'0_Vja0�e6SDrayOnIV,NOf +D <br /> 6. V r� f hU. n,1 t.✓1 /lQ-fJl rN%/ �n Ma m M chi M n : m <br /> m x3 nm `s am <br /> 9 0 T C H N 0 = 3 <br /> 7. Z C N ry O ° 0 1 <br /> O m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my A <br /> C <br /> racy of <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accum <br /> ecognize m m <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 r <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- i in O <br /> O : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am z : <br /> m : 0 : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the abqM describ remises at any reasonable time for the purpo a of in pection. <br /> TI a <br /> fn <br /> 57 > € <br /> SIGN HERE / n <br /> n <br /> (signature of owner or building contractor) <br /> (date) o <br /> of <br /> ZONING ADMINIST TOR �lM F)Q6102C) <br /> vON (P W W NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N o u v u o <br /> THIS PERMIT SHALL EXPIRE 011E YER FRM DATE OFFS UA CE <br />