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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator vM Z <br /> APPLICATION FOR LAND USE PERMITS _. <br /> r <br /> rn o <br /> y <br /> C <br /> OWNER -, SwC� SOy� TELEPHONE 7 'S q�-407' m <br /> n <br /> O e <br /> w <br /> �ySl�Ooc��ee L`� �d , Shy(( s�89/ ^^ <br /> MAILING ADDRESS °f <br /> W 0 m <br /> �v o <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) � , 1 a G T 9N I y C-tJ m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE V ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): C <br /> FILLI GRADING CAMPING UNIT ❑ SUBDIVISION ❑ 33 <br /> A .S STRUCTUREADDITIONUSE: eLeoI rs y <br /> ' <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �� w <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 -- <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In <br /> NORTH(N). <br /> n <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 Z <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 C <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I 0 <br /> N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> 00 <br /> MUST BE SIGNED AND DATED BY THE OWNER. = -- <br /> 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � 0 7•� <br /> NEEDED. C> <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: D 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. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY CS <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m1D- aF �1 0, I6. afl <br /> a <br /> ry C <br /> 7. <br /> O Z m mG <br /> O �`o <br /> -n <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —�^ D <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w vi C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c o v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized son to have access to the above described premises at any reasonable time for the purpose of inspection. T m CD <br /> o <br /> m <br /> m � 'm <br /> SIGN HERE O3 vi <br /> ig tura of ow building contractor) (date) q n <br /> ZONING ADMINISTRATOR (f� <br /> in i» <br /> O N� O O <br /> 6 U <br /> TOWNSHIP PERMITS MAY BE REQUIRED CP 00 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />