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Burnett County 7410 Co. Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER �(%). rCc fdTCS�C�_, TELEPHONE <br /> MAILINGADDRESS wcmnl <br /> PROPERTY ADDRESS <br /> (b <br /> LEGAL DESCRIPTION(see tax receipt) N <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ N o <br /> TYPE OF PERMIT(S): <br /> FILLING/G/RAA NG LJ CAMPING UNITY ❑ SUBDIVISION ❑/ / n <br /> STRUCTURE/ADDITION USE L���.�I ���tD �� � b4''� GANG} Per Rbf-p64'ry 0 <br /> Hobin; Comme tial Busi ass; B room; Deck; etc. U� <br /> (Home EEEJ��q fTI ) � <br /> BUILDING CONTRACTOR: (l. y <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 9 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tj m 9 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m .o <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. C;' <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 0 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. r'y' <br /> w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (AI <br /> CONDITIONS OF PERMIT: o W <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. c <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (V"l <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WA,TF=R <br /> SETBACK,AREA. / /1LF� ^}I �A,e-, n,a <br /> 6. o m A E m <br /> m Sam �c LL m <br /> o A C y m j <br /> 7. Z m m o 0 p 5 <br /> o m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m — ^� - : : O <br /> PP f 9 Y ) Y Y c)2 c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m m vi <br /> o- c ut 'D <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m S o ; m <br /> that this Information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- <br /> P 9 P Y ty n [ � ; <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 <br /> providing in this app ation. I agree to permit county officials charged with adin of r <br /> authorized person hate access to the abo e d m <br /> ibe re ' es at any reason t r 14 0 s I ' m C <br /> SIGN HERE i <br /> (sign re few b ' Ing contractor) NOV [ <br /> ljdlla n <br /> ZONING ADMINISTRATOR L J <br /> BURNETT COUNTY �iq6 is -" <br /> N n I N N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING (1 o u n o 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF 1 SU CE /l! <br /> PUm�� + le� kfplcLO cep by L n 00dir) 11- 1r7-6tZ;-- <br />