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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> m o <br /> N <br /> n 1 <br /> OWNER /�6�G�-I J SC/�I TELEPHONE <br /> MAILINGADDRESS G's^� / CCC /(et //at�g��I ��� S�V�-'7U (' 0 <br /> PROPERTY ADDRESS Zlk It/2 C(I/ <br /> f <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ m O <br /> TYPE OF PERMIT(S): Q �'- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n — <br /> STRUCTURE/ADDITIONUSE: /!ao C<((.- 0 C� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) to <br /> m <br /> � <br /> BUILDING CONTRACTOR: lJRR �rf <br /> d� T< tr � <br /> / tgS Cq <br /> v <br /> m <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. m <br /> O <br /> ZI y Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 'r+ z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NS)AND INDICATE m 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 \ B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF q, z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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 /> 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 C <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o 0 CnJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C> <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 /> m m m W n MO n ° m <br /> 6. m F3 nm Fay= .�7 <br /> 0 om CN `° 07. 57+ <br /> Z C u, m O <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �'c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of Cj(� n A <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize �[ m ; m0 <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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access t%Ikle above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> m <br /> SIGN HERE " <br /> (signature of owner or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR m <br /> �69 ER 63 bi�N <br /> O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED u o v u o <br /> THIS ERMIT SHALL EXPIRE ONE YEAR FROM DAT FIS UAN E <br /> elmi� � lef�2� PIC_" � L? d � Sen <br />