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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator m ci Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> " o � <br /> OWNER / l k 1 gt �J K /f e ✓ t) 1 ej TELEPHONE /S Z-3z2 <br /> Z /`E o n <br /> v <br /> MAILING ADDRESS /_3 7,0y 6�5cr k-i2.f til v sJ� � f� S �a ° p <br /> v�/,!p / �/ °r <br /> PROPERTY ADDRESS Al (J ���o+,w <br /> LEGAL DESCRIPTION(see tax receipt) W t a CS <br /> :J �/ lF <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OFPERMIT(S): cn C � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a ' <br /> STRUCTURE/ADDITIONOSE: Gee mac �«!�'` /�x / '(((drcum o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> // 7 <br /> BUILDING CONTRACTOR: /7� �ntiST+^tc <br /> v <br /> 12 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "n <br /> y Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m � � <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In c <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t c <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. �p <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 Oa <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 <br /> N O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> CONDITIONS OF PERMIT: P <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINI WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBA K AREA. <br /> 5. G(�K tL�lu�►nr_(7 .6 eY l�� -�1�6 /, (g (� tD�//S,s ue-, <br /> 6. n� -D� I u SjG� ho, f c4os-eI' l U LC -k4F/, �. -� s/ / m ID cr 00 m a f m <br /> m 3 'apx° � � <br /> 7. Z mm0N (a <br /> o i T M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �(� 2-i i D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of -p .F y' 0 �, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize N m ; o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i G <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 application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ` m Cn <br /> -n OCD <br /> : <br /> SIGN HERE Q �� !/ /mss�v e D- <br /> n 441 is 1 O vi w <br /> (signature or building cont ctor) (date) o. <br /> ZONING ADMINISTRATOR Q O : <br /> O € € s <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE aa�7GS_ <br />