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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o _ o <br /> APPLICATION FOR LAND USE PERMITS <br /> N \ J <br /> OWNER � TELEPHONE <br /> m , <br /> MAILINGADDRESS 'v ,� �' O <br /> � s <br /> PROPERTY ADDRESS t-�, �1... 1, <br /> LEGAL DESCRIPTION(see tax receipt) i/z f ) S T <br /> '�z � +Jr� -Sv�_ Z"+ T <br /> DWELLING/BUILDING R GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ \ \�m o V, <br /> TYPE OF PERMIT(S): Q <br /> FILLINGIGRRAAj�jING ❑ CAMPING UNIT ❑ SUBDIVISIOft7 )E] <br /> STRUCTURE/ADDITION USE: / �{�%��i� I � lr(lcl LIYI _ ° <br /> (Home,Cabin, Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: �i(i( GGI <br /> m -1 . <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'G X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a -{- <br /> T <br /> T O Z <br /> ,,V.- ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d A <br /> !r' -SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). / y� . o <br /> 3. SHOW DIMENSIONS IN FEET OF TH FOLLOWING: �A1"BUILDING(S)TO ALL LOT LINES, UILDING(S)TO m <br /> CENTERLINE OF ROAD, ING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ' P <br /> 4. SHOW THE LOCATION OF THE WELL4W}-SEPTIC TANK(S,J?.HD-OKAINFIELD(DF),AND ALL DISTANCES TO <br /> _pUttDINGS, QAADS, LAKE, ONES. ,.S <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 6 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS , ° t <br /> MUST BE SIGNED AND DATED BY THE OWNER. f Ui <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <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 /> 71 [DOr DO DO <br /> m m m 0 m a f m <br /> 6. m F 3 n m N a m A <br /> o m C o 3 <br /> 7 Z J � <br /> O m T A <br /> = m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. 0 r" A <br /> all information contained in this application (including any accompanying schedule) and I further declare that I recognize m ` M <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D m <br /> sue a permit. 1 further acce 11 liability which may be a result of the County of Burnett relying on this information 1 am m o <br /> providing in this plican I agree to permit county officials charged with administering county ordinances or other <br /> authorized p to he ccess to the above described premises at any reasonable time for the purpose of inspection. 1D n <br /> T <br /> 9a <br /> SIGN HER <br /> (sig aJtJure of Lown/err or building contractor) (date) o <br /> ZONING ADMINISTRATOR �4�� � I LLA ✓I �.11 �i.h <br /> 4rl(h,5 <br /> TOWNSHIP PRMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />