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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c Z <br /> APPLICATION FOR LAND USE PERMITS 3 g <br /> r <br /> y O <br /> w T <br /> OWNER J, ` M S C///1 d N TELEPHONE 416 8— 7Z <br /> o if <br /> m <br /> m <br /> O <br /> MAILINGADDRESS 23(o7 7 p eTIP /(o, )AV I ( La ke Ckir v <br /> c519 w!E S-41 1— <br /> PROPERTYADDRESS <br /> ).J <br /> LEGAL DESCRIPTION(see lax receipt) 4,7 O <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 0- Ln <br /> TYPE OF PERMIT(S): ii <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: 'J E CrL- 0 V I r <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) O -� <br /> F m <br /> BUILDING CONTRACTOR: S, �. <br /> m C <br /> v S ` <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m DQ <br /> A � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m A. <br /> NORTH(N). <br /> 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 9 <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS Qql <br /> MUST BE SIGNED AND DATED BY THE OWNER. F ) <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (b <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. <br /> m co m M n M n ° m <br /> 6. 3 ."0 <br /> v <br /> 05R7. cN !' o � 3 <br /> Z c H o <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> c v <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 f m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `� 00 : q <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 o I <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ' ,o <br /> authorized person It ave access to the above described premises at any reasonable time for the purpose of inspection. m <br /> T a : <br /> SIGN HERE <br /> sl nn tjur�eof down building c <br /> ontr <br /> actor) (date) <br /> ZONING AD ISTRATOR U L L y) <br /> X69 df fA fA � N <br /> O N (n lJ (J N O <br /> ONO (li NfnO <br /> TOWNSHIP PERMITS MAY BE REQUIRED (� <br /> THI PERMITS ALL EXPIRE ONE YEAR FROM DAOF I UANCE <br /> �E y �'�rneS LI ff 6tI s-a L/ -tom <br />