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r <br /> Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator ' c o <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> .D <br /> / m _ <br /> TELEPHONE <br /> OWNER �'£ � V) <br /> n CD <br /> MAILING ADDRESS SJ A7 <br /> PROPERTY ADDRESS 7 { S <br /> LEGAL DESCRIPTION(see tax receipt) Ko l Y 5k) /y S l '7 r O p Q 1 lot Q 11 J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 19 CIS V, <br /> ,.4� r�✓ C <br /> TYPE OF PERMIT(S): (/J 'O/ a <br /> FILLING/GRADING ❑ CA PING UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USE: a I b k b q 3 a O-U a n d <br /> (Home/Cabin;Codimercial Business;Bedro ; Deck; etc.) c <br /> BUILDING CONTRACTOR: ��C.t) "�S ► Z �Y� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OW <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). W3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. ° b <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS l �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI Y PIE WHEN <br /> NEEDED. <br /> G <br /> S <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Ale lG o <br /> CONDITIONS OF PERMIT: n 7z� <br /> LA1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF Pf RMJ�/ l /"ISSUANCE. >ffJ�NC2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIff <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (;OO <br /> Ty <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER �- <br /> SETBACK AREA. <br /> 5. 6/151�2 8 O iC <br /> � <br /> V� qe 3 0 x E M <br /> / � m CL <br /> s. (zL ' d my _ <br /> CD. C <br /> O 7 <br /> Z O O C <br /> 7. m <br /> E �rnE E O <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> N` <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- ; f <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 <br /> O€ <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> m E U): <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - c <br /> (� m SD <br /> SIGN HERE fi V— <br /> (signature of owner or building contrac r) ` (date) : <br /> ZONING ADMINISTRATOR rn 1 fin r � <br /> f uN o c ib o <br /> (Yl� TOWNSHIP PERMITS MAY BE REQUIRED w <br /> ��TWiSqERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />