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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 f <br /> UT o <br /> CD <br /> OWNER j G W TELEPHONEJf}T� {1 � 2C 7S ''q c <br /> / p <br /> MAILING ADDRESS � S/Y ?� 1' �� sP �N�Jr /jfL� :230/6a/6 v o <br /> Cj� <br /> r � <br /> PROPERTY ADDRESS �'6�6 �0 4 �i c,1fi,.C�n(•• L7L� V/ `� '"" ,'/ yg,� , ^ <br /> LEGAL DESCRIPTION(see tax receipt) s � � ��� � � ' ���—y6f(3—a/ S�U <br /> (D <br /> DWELLING/BUILDING Lrl GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ �I ( o <br /> TYPE OF PERMIT(S): n <br /> FILLINGI�G+R..,,A,,DIING ❑ CAMPING UNLIT 1:1 SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: ` LYY)Ph. �f r 60� 5� ° <br /> c (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ( W f <br /> P V) <br /> BUILDING CONTRACTOR: �C m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n0 O t� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> -n ^ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m O J <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 ' Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. I <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o tJ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z t <br /> CONDITIONS OF PERMIT: t <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. ` d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY y(Jnl <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. b n SI k' Or- CG <br /> (D c m ei n M a : n1 <br /> 6. m 0 3 <br /> 0 N C y fn 0 = 3 <br /> 7. Z C y N 0 : = O <br /> (D -n`G : <br /> - cn : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP ( 9 Y ) Y Y J � : <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of m �_ C' <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize J m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informal' I <br /> providing in this application. I agree to permit county officials charged with adi i her <br /> authorized per n to have acc s to the above described premises at any real I f p 0% 44i n. m a <br /> -n <br /> CD D : <br /> n : <br /> SIGN HERE <br /> �siyg' ure o/f/oy�w{ner or building contractor) AUG <br /> ZONING ADMINISTRATOR lir Wf <br /> BURKETT mww� <br /> ZONING � N Ut W W N <br /> O Ul O N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED G� <br /> TH PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANC <br /> PWM -fb- I844e� �YICu 1 ed � �h d ,4 Arn' hGc�'l2 <br />