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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o Z <br /> APPLICATION FOR LAND USE PERMITS 3. ylJ.9 <br /> Q <br /> 0 � <br /> N � <br /> OWNER J!m L S / `U r/ ) 5e,,/) TELEPHONE <br /> MAILING ADDRESS Po So �S� G lI&M <br /> PROPERTY ADDRESS <br /> W <br /> P11-1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING 1L]l GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (f"i (n <br /> TYPE OF PERMIT(S): rJ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: o/t±e w <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> m <br /> BUILDING CONTRACTOR: OWI")�fe, d' Lnr <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. 0 <br /> ;1 N <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. 0 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 a <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 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. `2 <br /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <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. <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 /> X cO oOi m > � Frit <br /> 6. o c 3 <br /> N C y N O <br /> Z C N ry 0 ? <br /> 7. O N : M1Z a <br /> : r.Zl <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m ^ ` O <br /> PP ( 9 Y ) Y Y �., C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; d <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize [ m $ E [ i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 /> Wm o <br /> providing in this application. 1 agree to permit county officials charged.with,a}ImFmIpterjn_IsQ uri y ardinances or other ,$ C3 i <br /> authorized person to h access to the above described premises ata oli go thAl fgr4q p r poile of inspection. 1p a <br /> LJ: <br /> T <br /> SIGN HERE <br /> (signature of owner or building contractor) I, ROOC (d e <br /> T---�'' G J <br /> ZONING ADMINISTRATOR VIM I 1a7���1�'✓� ! ' ' � E E E <br /> TOWNSHIP PERMITS MAY BE REQUIRE-JPNi o m o m u, v <br /> PTHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS$SUANCE <br /> �rytiT 4- L-P- , sevtL-tD --00 <br />