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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS j. <br /> r <br /> ^-7 N 0 <br /> TELEPHONE -715� -(o/j; / <br /> — 7, <br /> m <br /> MAILING ADDRESS <br /> d 7 �L a L'-/ ° <br /> CD <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see lax receipt) 03 Z- — y Z s— 02 40d d 6, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION I� ` (n O y <br /> TYPE OF PERMIT(S): C ' F <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °° . <br /> STRUCTURE/ADDITION USE: I3 -t?7(/w G 0 W <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn ` k P <br /> y <br /> BUILDING CONTRACTOR: �© �/ � G O�S�� v <br /> _ ? 1 <br /> � r^ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m WJE <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n0 O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C \ O <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(OHWM)OF 1 <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 G <br /> BUILDINGS, ROADS, LAKE, LOT LINES. W <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 ° Y <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ?"�Zs O <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT `V ` <br /> ISSUANCE. <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. �p <br /> 5. S Lt Tb �horQ�(tn�i �u��er �25`t�/z; 17dr` (�gr L .C.O. yV <br /> I" �] 0a DOD <br /> W OM <br /> m ( m <br /> 6. <br /> m x3 o. ID yam A <br /> p m C y y 0 Ej3 <br /> 7. Z o <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — q : D <br /> PP ( 9 Y ) Y Y E �C C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c u <br /> 9 P 9 P Y \ � v 0 ' <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- cn : O <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 v o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person t_94yave access to the ribe premises at any reasonable time for the purpose of inspection. m <br /> -n n <br /> CID I D <br /> m m <br /> SIGN HERE <br /> (si na re of own building contractor) (date) �' o <br /> ZONING AD INISTRATOR <br /> F»F»F»yr <br /> G o V 0 U N <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Inak le d -f� b rnA2, -Trte-1 �f-��- <br />