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ON COMPUTER/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 Z <br /> M o o <br /> APPLICATION FOR LAND USE PERMITS 3. � <br /> r <br /> c <br /> m <br /> c� �c � F s 7/ �S~� 33��OWNER TELEPHONE o <br /> m <br /> O <br /> MAILING ADDRESS ���?4i ��� �(^� A,'t <br /> PROPERTY ADDRESS �.�(��� �ft j (,1 �i�C' K I �G a'1 4 �fT f/ A.- o <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ ( 0 I <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> a � N. <br /> STRUCTURE/ADDITION USE: <br /> (Ho e/Cabin; Commercial Business; Bedroom; Deck; etc.) v <br /> BUILDING CONTRACTOR: tun px2 01 <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O - <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m C n <br /> NORTH(N). (n 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO Im -o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 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. 1 <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 0, ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. jI <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> Lij <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. <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. This structure to be used as Private residential <br /> 5. garage/storage only. Not to be used for human W r r o D o v <br /> 6 habitation. 0 ; 3 a 2 0, a � <br /> n 7 7 0 M d <br /> p m C Cn 0 3 3 <br /> 7. o (2 m <br /> cn : �: !O <br /> declare that this application (including o..r o.,.,...Na..y...y �.����...�� ..o� ucc.. cnau m.cu vy ...c anu av anc Uest of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- : a : CO <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 w o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j <br /> authorized person to have access t he above described premises at any reasonable time for the purpose of inspection. CDn <br /> m <br /> m > : <br /> a : <br /> SIGN HERE � �"�' / - <br /> a <br /> (signatuf ow or building contractor) (date) 0 <br /> f i <br /> ZONING ADMINISTRATOR ) 1�] C/�J��y( <br /> _/ 1' ( 1 IQ <br /> W o N <br /> of rc <br /> TOWNSHIP PERMITS MAY BE REQUIRED p�s' o cNi. o cwi. cNi. o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA CE <br />