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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 <br /> y O <br /> (D <br /> OWNER ® TELEPHONE /�� 3 9— QRZ p C� <br /> w <br /> MAILING ADDRESS 3�G� ��fij}�,r� �(/ �ir! S %� CDw <br /> PROPERTYADDRESSS� /1//jy/� �; /(� �y✓NSN/ ! \ <br /> c <br /> LEGAL DESCRIPTION(see tax receipt) L ` _A0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ cn A <br /> TYPE OFPERMIT(S): Cr <br /> FILLIN / ADING C PIN UNIT ElSUBDIVIS107 ^ Cr <br /> J c.�-tJ <br /> STRUCTURE/ADDITION USE: i l� &Ziia n <br /> ( ome/C bin;Commercial Business; Bedroom; Deck;etc.) / m JU <br /> BUILDING CONTRACTOR: _�� m <br /> 4 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o. <br /> ?t o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N <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(CHWM)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 C>O) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION , )NE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> �Q� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE'"'''!Y 9 .� <br /> ISSUANCE. 9,�, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINEZ$>>, I <br /> 3 NO GRADINGTTED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �O�//!CO <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED W% <br /> SETBACK AREA. [ � ��� �J <br /> i /'�'� �''l <br /> 5. 15 �,G � QIIL(.' M 0r- a0D010 <br /> 6. G�1(al ( S camsd - Gla /11 ,fid 0 3 & 20gFm <br /> L '�, m. 3 a m �c m <br /> � o v m C y N <br /> 7. tj �Jtl C , C�ch �rTnlhd C,�` � Dtt ))'Y1 T� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and tote best of my Lj C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v, <br /> a ^ <n : M <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize ` : o M <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have acMs to the above d bed premises at any reasonable time for the purpose' f inspection. -nm : o <br /> SIGN HERE <br /> (signatur owner or building co r r) (date <br /> f i <br /> ZONING ADMINISTRATORIz.1 E <br /> N. IN O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED (l @ Q J c <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE — � � � <br />