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Burnett County 7410 Co. Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator -0 C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> OWNER ( l �It M� ��� l*iCy�L�B��Z�R/c�t C���ucm*HONE� �. 'C — `t() l fJ n <br /> jj�� /a ,,y� y/�� c� 0 <br /> MAILING ADDRESS o 11!��a SI- k(� � �If� V�'lr �e /�N J��/Q o O <br /> PROPERTYADDRESS 2Z�( "t'L ��,,JN y � � � t o <br /> 1 ��CSM �3 Cr( ref t t -rrca �a <br /> LEGAL DESCRIPTION(see tax receipt) 7c� <br /> F r 1�1 C <br /> ) <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ADDITION ❑ to o � <br /> TYPE OF PERMIT(S): c <br /> Q <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: fIc%fE o <br /> (Home/Cabin; Commercial Business, Bedroom; Deck; etc.) rn J <br /> BUILDING CONTRACTOR: <br /> `c <br /> m � <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON.AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> ,n a a <br /> T j� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n � � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). c v c� <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 I <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. n 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. � g <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 71� O <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. ty <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> O <br /> CONDITIONS OF PERMIT: o(.` <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. r 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W C I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY oC+ tb V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER a <br /> SETBACK AREA. /� c '^ (� I�I dj-0 „� <br /> 5. C I5gC oL CA ` J- b `� � re- 1,"n5 C)h T' l r 1' <br /> tRbOt ��+� / <br /> CD d d - nis. yalvmt�� -Of-lay nW m <br /> - a � <br /> omcy ." o � �+_ <br /> 7. Z C in ID 0 7 <br /> O m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my — A <br /> PP (� 9 Y ) Y � O� � C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- V11 to <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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person ave access to the above described premises at any reasonable time for the purpose of inspection. '" <br /> T d <br /> m D <br /> SIGN HERE _ Lt /" l iyJt,. �.0 f. % �t S a <br /> (si nature of n or ildieg contractor)�c (date) o <br /> STRATOR <br /> ZONING ADMINI �i <br /> O N (P W W N O <br /> �OUIOUt Ut (TO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />