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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator 'a ci Z <br /> APPLICATION FOR LAND USE PERMITS <br /> s <br /> OWNER G.0 �, /QQ/K' TELEPHONE 71s�y3 5-Zj'(i'I Z <br /> ,. <br /> MAILING ADGDRESS <a o� G ;iti tea(_ SOI✓V` W)i S[p(J I ? <br /> r c � <br /> PROPERTY ADDRESS ?t <br /> LEGAL DESCRIPTION(see tax receipt) L 5 ` IQ CSM ✓ )v P / I1 //J / I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Q ADDITION J❑b (—`t'C1 ,y 7 <br /> �i y j <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADI4GI❑n CAMPING UNIT ❑ SUBDIVISION ❑ E � <br /> STRUCTURE/ADDITIONUSE: <br /> (Rome/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> vv. m <br /> BUILDING CONTRACTOR: �� ! �/J/1. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR C L <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) C) a 1/\\ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T 6I- ? <br /> 0 Rt2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF r 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 W <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTO CETC.,THE PLANS nn 11 <br /> MUST BE SIGNED AND DATED BY THE OWNER. /� m o N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIO Y fR- . o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 7 � '! Z <br /> CONDITIONS OF PERMIT: 2 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITe�•T VF� = <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 2C�I/�/ ® f ', r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. po\ tks <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 6 SETBACK AREA. no Wh 77 <br /> 0 w 0 A M F <br /> s. e a4�►sed rYwasLtres fo frbst prods -�rec f u\/7 1D prok� I�t,44 3 a m W a a � <br /> 7.# ere ' S �S �'r Fi 11 Pla0-a � 5�-a9� y� „� o @ m <br /> to T <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my f D <br /> ` C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of cm n ; <br /> all information contained i is application(including any accompanying schedule)and I further declare that I recognize m C 0 : m <br /> that this infortion m prove ing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <br /> is v: <br /> e <br /> sue a permit. I fur er accept a 1 liability whi h may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this pplication. agree o p mit county officials charged with administering county ordinances or other m i <br /> authorized pers n to have ess to ove described premises at any reasonable time for the purpo a of Inspection. m ; En <br /> m O c <br /> SIGN HERE <br /> v+ w <br /> (sig } ner or bu g contractor) (date) `• <br /> CL : <br /> ZONING ADMINISTRATOR m <br /> ' 9 Ad o <br /> ^^`` TOWNSHIP PERMITS MAY BE REQUIRED <br /> c <br />- 6"� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE i <br />