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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 C) mac/ <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r- <br /> 0 ^_ <br /> O rD `T) <br /> OWNER J C) h ����A N TELEPHOI Sj d_ 71 ] � o <br /> MAILING ADDRESS a ��� ,_ �, G /� fD > Wb•� <br /> YL � m <br /> PROPERTY ADDRESS ,S'Am e� I I1 <br /> LEGAL DESCRIPTION(see tax receipt) PCI <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o <br /> TYPE OF PERMIT(S): l�� C 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S BDIVISION ❑ 1 a <br /> STRUCTURE/ADDITION USE: _ /C f�f I C' S e L /e N J� <br /> o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: P. L <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR N <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) A <br /> O a O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o Z �l <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO M 3� y <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 'R 444***.." <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o Z <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. L <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE W Y <br /> NEEDED. �.� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. f_ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ((Uva} <br /> 5 ,SETBACK AREA. <br /> 6. (D m . 0iiCL :E m <br /> a r m <br /> N <br /> 7. W j <br /> Z N ,p O : 20 -� <br /> O : T Q it <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my =rn A <br /> knowledge and belief it is true,correct and complete. 1 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 I recognize m o m <br /> that this information 1 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 d <br /> providing int plication. I agree to permit county officials charged with administering county ordinances or other <br /> ji <br /> authorized¢erson t have acc to the ab ve de ibed premises at any reasonable time for the purpose of inspection. m (n <br /> -n0 <br /> O O : <br /> G <br /> SIGN HERE 111v'71-- j p <br /> (signature of owner uil contractor) ' o. E <br /> (d e) <br /> ZONING Ml STRATOR <br /> 69 <br /> N (1 N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED N O <br />