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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator v 17 Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> N <br /> C <br /> OWNER TELEPHONE <br /> 22 n �' <br /> m JP <br /> MAILING ADDRESS lL�� L/ jo,e/o 4 e /f BJ P, lam'- S .Yi4ti f j <br /> PROPERTY ADDRESS 3 Q r f i" ic1 J <br /> 14 tAar� /;I - /3 39�/,Y9 PPI. y/•/J'/?,O2Xo <br /> LEGAL DESCRIPTION(see tax receipt) /j/�y f/ 2 t t� (� 0 d LLy <br /> DWELLING/BUILDING I GARAGE/ACCESSORY STRUCTURE ❑ ADDITION L,A pt <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UN T ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITIONQSE: A �i �� <br /> (Home/Cabin;Co mercial Business; Bedroom; Deck;etc.) <br /> � Y <br /> BUILDING CONTRACTOR: 6 L 0 Yl -f/" <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � C� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 0 y _, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a 1� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 nt 3 <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. V�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. c V} <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. (,"0 0 <br /> rr NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI ATILc� N@LWH / ,, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. JUL 1 .9 0 <br /> CONDITIONS OF PERMIT: BURN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ETj COUN7y <br /> ISSUANCE. ZotV/NG <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. [n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER v+ <br /> SETBACK AREA. <br /> 5. <br /> M 0m> vaov <br /> 6. m 3 a n <br /> v m <br /> C'0 S <br /> 7. <br /> 9 "' : ': m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m 5 y i O <br /> PP ( 9 Y ) Y Y �C i C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i m <br /> a~ i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ` m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is• �J1 <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this Information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to ha access to the above described premises at any reasonable time for the pur ose of inspection. m <br /> m <br /> SIGN HERECL <br /> (sign er or building contractor) (date) <br /> ZONING ADMINISTRATOR �'l <br /> I ' �^�'� _ TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />