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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 1 - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> I_ o. W <br /> OWNER l O tJ l Y` I� V TELEPHONE �S — s(Q6 —((,--D�V// o <br /> MAILING ADDRESS 17 LP WLO/id DW&-M&)fJ Pr N JJ l/Id' <br /> o <br /> 0 <br /> r m <br /> PROPERTYADDRESS IIAA nn I <br /> YVlftill— <br /> LEGAL DESCRIPTION(see tax receipt) O �� e� �Pm-r- U .��^ (✓ S <br /> DWELLINGIBUILDING7 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ N O <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑� ISUBDIIVInSIOON ❑ <br /> STRUCTURE/ADDITION USE: �)1 N ' "0 0l lilLJ a)r S <br /> ( e/Cabin; Commercial Business; Bedroom; Deck; tc.) cn <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR r 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 '` <br /> A « J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O C <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I ` 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 i 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 (1 <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. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> n. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o G) <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Q C <br /> PERMITTED. h <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ; 0 m [u > 0 Da� O V <br /> > m <br /> 6. m Hca nmx A <br /> v o m c y ." o5 3 <br /> Z <br /> 7. o <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y ` G) <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of a <br /> all Information contained in this application (including any accompanying schedule)and I further declare that I recognize m ` 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ` cn <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 Fi <br /> o <br /> providing In this application. I agree to permit county officials charged with administerin eri ,o E <br /> authorize on to have acce ve described premises at any reasoRab <br /> T <br /> n i <br /> SIGN HERE 1l1p1( ` a <br /> (signet owner or b ' g JUN 1 2(dateUU <br /> ZONING ADMINISTRA <br /> fA ER fA fR� N <br /> BURNETT COUNTY G g N o N N o <br /> TOWNSHIP PERMITS MAY BE REQUIRED kyNING a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE O IS U <br /> Permi}4 1e4-Y/- �l Led it . ashavy <br />