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Burnett County 7410 Co. Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS �� <br /> qs� y o <br /> n <br /> OWNER r L aN TELEPHONE &prizol3J 7 05y <br /> v pp <br /> MAILING ADDRESS <br /> Rc1 qq �Gt2N I"rGrlr�� �Gfl� trY� f,r'`-J <br /> � <br /> PROPERTY ADDRESSor <br /> 9� �- I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY TR CTURE ❑ ADDITION -(� o <br /> TYPE OF PERMIT(S): c <br /> � D^NG <br /> CAMP) NITSUBDIVISION / a cz <br /> FILLING/GRADING ❑ ❑ <br /> 5. <br /> STRUCTURE/ADDITIONUSE: oLzz\ y <br /> ' <br /> / (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) j Q <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8�/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> Np <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m b <br /> a <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> n <br /> NORTH(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)OFZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. -C--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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o z <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN n o <br /> NEEDED. n n <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P (� Q <br /> I <br /> - 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <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 /> U�,al�,ak Perm�f a oSBo � pciij YPdr — A" <br /> /�A / G / a 7L'�L/ /J P /�. 1 //� m �to n(D a F m <br /> 6. 'f yr G i �rT� L / ��/ m. O O N N n N >7 <br /> � O y N 7 <br /> 7. Z N (p O t0 <br /> S� O -n G m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the" est of m O <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 ofC <br /> EL a ii» <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize . m . o C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to isCD <br /> - <br /> sue a permit. I further acce � 1 liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this applica ' I agree to per t county officials charged with administering county ordinances i other o <br /> authorized person to access to the ve described premises at any reasonable time for the purpose of Inspection. m <br /> m o <br /> SIGN HERE <br /> u of owner b Ing contractor) (date) \ i n i <br /> ZONING ADMINISTRATOR O <br /> TOWNSHIP PERMIT0 01 <br /> S MAY BE REQUIRED <br /> l� j�nrG� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />