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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> OWNER <br /> e �/s ©rt TELEPHONE 7/S- 540 0 <br /> o (1 <br /> MAILING ADDRESSD S A� �� G��,n -6 <br /> V`t UUU V r + o <br /> S/6 9 /�a1-k S -lref Ilan bwyy AJ- s�t8+la s <br /> PROPERTY ADDRESS e. -5y p�0 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB S ON ❑ <br /> �'�'`` J < <br /> STRUCTURE/ADDITION USE: l '`Amt (� ( _ ?J� ` <br /> Z (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> /� nn m <br /> BUILDING CONTRACTOR: O/I* (� (f Qn S 4rct.C "O '\ <br /> r <br /> ' 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/.X 11 SHEET OF PAPER. ANY INCOMPLETE OR o `� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3. Iii <br /> J Y � X y <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) D <br /> � a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T <br /> o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n Am ;? <br /> NORTH(N). c 1 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m d -*�' <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. 0 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO fi <br /> BUILDINGS, ROADS, LAKE, LOT LINES. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N\p O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS o /V <br /> MUST BE SIGNED AND DATED BY THE OWNER. Gr (y <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �g <br /> NEEDED. J� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m � r- . W q, * M <br /> a�c3 am 0 <br /> m A <br /> -o om Cy ." o3 <br /> 7. Z ammo <br /> o <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best omy f a D <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 1 further declare that I recognize I` m E I m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ! ; m D <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 to the above described premises at any reasonable time for the purpose of inspection. <br /> ( n a <br /> n S- /S- dG a <br /> SIGN HERE m <br /> to <br /> (a' a re er o building contractor) (date) o` i <br /> 0 <br /> ZONING ADMINISTRATOR <br /> stn i»vi i»� <br /> • ONUt W W <br /> 7}� TOWNSHIP PERMITS MAY BE REQUIRED u, O <br /> THIS IPEMTHAI� /DEXPIRE ICnONfrYEAR ]'\O ' y_ El��(/ �E Sdh ���-�b <br />