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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - C 0 <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> r <br /> y O <br /> N ('� <br /> N <br /> d <br /> OWNER �� TELEPHONE o <br /> m <br /> n� // <br /> MAILINGADDRESS3333 f-�/ o-le 2141 c/'. <br /> r � <br /> PROPERTY ADDRESS <br /> / / / 1 <br /> LEGAL DESCRIPTION(see tax receipt) rt O� (>Pd <br /> DWELLINGIBUILDNG ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® O <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADNG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> SC r-cAm 1b X 1(0 �RP lC1 CSS c tSfi Q L�� <br /> STRUCTUREIADDITIONOSE: G/z�i I � � <br /> 0. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> c� <br /> BUILDING CONTRACTOR: Adk/G"Wi hUi /C&-S /AG- m <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR r 3 1, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 — \� <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) 0 n <br /> T � z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C v n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m E <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <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 0 N <br /> MUST BE SIGNED AND DATED BY THE OWNER. f r^te <br /> O � T <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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. w� sc r2en porch n -}o eweed fb Fri+. <br /> ma^1 k IceA Cross fror�l of ��bin. 6K (1' C m m °O m a ° m <br /> 6. m x3 'om Ox ;0 <br /> -6 p N C y N 0 ] <br /> 7. 0 , Om <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — N E^ 0 <br /> PP f 9 Y ) Y Y ! cTH : c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `� G <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 o <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 above described premises at any reasonable time for the purpose of inspection. j <br /> r <br /> DE <br /> SIGN HERE <br /> (signature of owner <br /> or building contractor) (date) Q� <br /> ZONING ADMINISTRATOR <br /> O fA fA fA fA N <br /> PO N (lW W N O <br /> o �nocn u, �no <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEA FRO DA,T'E F ISSUANCE <br /> �e�m C� null GI �/v /o r rh nd Bay &I 6 0 L/ <br />