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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 <br /> y O TW <br /> c,1, N <br /> OWNER h r TELEPHONE ' �-� 10 3- �0 C,S 1 b a <br /> MAILINGADDRESS \l� 1 Iy 'lPa N( 4,({ 2 ®t'pr3K� hIII) O <br /> F <br /> J <br /> r � <br /> PROPERTYADDRESS d Y A to V ^(4 y ^� <br /> 1 � <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ N <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> Lam_ N / <br /> STRUCTURE/ADDITION USE: Ulu, A0 M 0 l.fi <br /> ( ome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ��t sa � t G© V c� ;li 51- <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 0C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n Vl <br /> ?t0 ? <br /> 1.1 ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2 .� SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NS)AND INDICATE <br /> NORTH(N). (cit o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> 'CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF _I I" Vl o <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. f'iW, 1 <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. V) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ' IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. t <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. _\ 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 <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 /> m m m d n M n °m <br /> 6. m x a n m 0 a <br /> om Cr <br /> 7. 0 � e A <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 C <br /> knowledge and belief it is true, correct and complete. I 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 C7 [ M <br /> Inn <br /> that this information I 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 <br /> providing in this application I agree to permit count officials charged with administering count ordinances or other <br /> P 9 PP� 9 P Y 9 9 Y <br /> authorized person to have ac s to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> A D � n : <br /> SIGN HERE <br /> (si net a of owner r ilding contractor) (date) c [ i o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED G O N O TNN O <br /> THIS PERMIT SHALL EXPIRE OPE YEAR FROM DAT lJ/�yGE <br /> P4rn,S,�-4 ie--�}P-r ptC_[Ca Vio IOL[ l�Y� <br />