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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> N 0 SJ <br /> N <br /> OWNER Soh-�j jar <br /> [ V� TELEPHONE �l 0—of!(J/ <br /> MAILING ADDRESS 17 3�� �1j4 1 (/ r l[/ �-/ ` j� / /G{/� O� <br /> N e1Ct <br /> -t-018 8`9 —r 'Istr' `s—S .a�L <br /> C (/LLr <br /> PROPERTY ADDRESSV� 0/�.79� C,"G�—j . � O ^ <br /> LEGAL DESCRIPTION(see to receipt) /—l3 , \ <br /> Srn V �� PI4� G�� yo-�6 UI <br /> CID <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C�, : I � o <br /> TYPE OF PERMIT(S): ❑ -4 ljj'S Vp�yy C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION �hj CCIL <br /> r <br /> STRUCTURE/ADDmONOSE: ��rS �� LGG�c e o n I`�' 0 \ <br /> (Home/Ca m;Commercial Business;Bedroom; Deck;etc.) <br /> Ie � <br /> BUILDING CONTRACTOR: <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> a1 4Z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) C <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> Z <br /> n d � <br /> 2 SHOW NORTHTNE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m C <br /> (N). n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 �� O <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE 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. 0 1 <br /> CONDITIONS OF PERMIT: i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q (�1 <br /> ISSUANCE. �c( _` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. p <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. y> 0 a 0 <br /> 3 am x � <br /> Z in m o fo -t <br /> 9 n 2 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — t, p <br /> ( <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 v+ c <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize 21 <br /> CD o : M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. I agree to permit county ojficials charged with administering county ordinances or other d <br /> authorized pe on t have acces to the ab a ascribe premises at any reasonable time for the purpose of inspection. <br /> m <br /> /lf o <br /> SIGN HERE <br /> 0 <br /> (signature of owner building contractor) o. ' <br /> of (date) <br /> ZONING ADMINISTRATOR �J I✓{7 (/J� <br /> N V 7 N N O O <br /> (lO (T N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />