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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 Z <br /> ..`�ss�� �i /� •��e CD <br /> N o m o <br /> OWNER \l J �r //V /'�JQ/ � TELEPHONE Qs�'laic J 7. �,t c..�> o <br /> m <br /> (ms <br /> OMAILINGADDRESS � <br /> PROPERTYADDRESS / <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> � o <br /> TYPE OF PERMIT(S): ❑ <br /> FILLING/GRADING ❑ CAMPING <br /> UNIT,�❑ SUBDIVISION �' <br /> STRUCTURE/ADDITION USE: <br /> ✓Oi71 E / E7//V #oma`!! 9 D�Ig(»�l fx/m%� o �. <br /> (Home/Cabin; Commercial Business; Bedroo ; Deck; etc.) P (n -- <br /> �/ v <br /> BUILDING CONTRACTOR: - TA-;wes; Mo!ify <br /> CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> r . <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O C q)~ `� <br /> -n a <br /> -rt Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Zs <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m rr ''` <br /> NORTH(N). y W o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m J) �3 <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I 1 <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. 1 <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 0 _r <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> F <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: o <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. , <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY o <br /> PERMITTED. (�) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER T <br /> SETBACK AREA. <br /> 5. <br /> CD C 0) aoaom <br /> 6. F3 a0 a � A <br /> co C: y y C 3 <br /> 7. Z C !/1 ry O <br /> O N n tArt <br /> I declare that this application (including an accom an in sch Jule has be n examined b me and to the best of m — r^ O <br /> PP ( 9 Y P Y ) Y Y � c � ; C <br /> knowledge and belief it is true, correct and complete. I a nowt dge that 1 responsible for the detail and accuracy of v n : cn <br /> all information contained in this applica ' (including jeo <br /> panyin chedule)and 1 further declare that I recognize m m <br /> that this infor 'on I am providing w' a elied up tunty urnett Wisconsin in determining whether to is- ° (n <br /> sue a perm' . I fu her accept all Iia it w ich m be rf t C my of Burnett relying on this information I amm o <br /> providing ' this pplication. 1 a e p mit c unt ffi r with administering county ordinances or other e <br /> mauthorized erso to have acces ab ve d scri d p t y reasonable time for the purpose of inspectio a <br /> T <br /> m <br /> D : <br /> SIGN HERE <br /> aWre of o er ddi ntractor) (date o <br /> ZONING INISTRATOR n : <br /> O�ffl fA EA 6, K) <br /> O N (JW W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM PATE O ISSUANCE <br /> �m��.� l e�+--lei�► �t p ,� -DS— <br />