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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 . <br /> o <br /> cya <br /> (D � <br /> OWNER TELEPHONE D S/) y o <br /> I m O <br /> MAILING ADDRESS �QS Sr)` �} S✓;y. 1eJ nJ„/; 0/ln �IaJ�L/y� ! �r / � � m <br /> t, 0 <br /> PROPERTY ADDRESS /C/y �y�nAili / ` � f��� G411 <br /> LEGAL DESCRIPTION(See tax receipt) !W v�) I SAya/ /0 4�i,,e 137 � � CD <br /> DWELLING/BUILDING ❑ GARA'GE/ACCESSORY STRUCTURE ❑ ADDITION cn <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: 3 SGIe q ° �J Q <br /> I" <br /> (Home <br /> a/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> Z <br /> 'o <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m C Q <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> Mf o (7 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m CD <br /> 9 :b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C 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 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 Q <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> S. 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. u <br /> 1% v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI <br /> NEEDED. I� u, 0 W <br /> ' � j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. j o <br /> CONDITIONS OF PERMIT: <br /> 2004 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM T{ l�VF� n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Zol�//NG �,VTy <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r i <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ) <br /> SETBACK AREA. <br /> 5. <br /> Q mwomCL :EM <br /> aOD 0,, <br /> 6. a 3 m C:ow H o <br /> Z y m <br /> 7. oT m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — O <br /> PP ( 9 Y ) Y Y q p C <br /> knowledge and belief it is true,correct and complete,, I acknowledge that I am responsible for the detail and accuracy of w Fn <br /> a : v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize p (D o mm <br /> that this information 1 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 yermit county officials charged with administering county ordinances or other <br /> authorized person to hayle accqfj*,toWflfbove described premises at any reasonable time for the purpose of inspection. (D <br /> 't ` 0 : <br /> / <br /> CD <br /> m <br /> SIGN HERE B <br /> A uof�or building contractor) (date) a <br /> ZONING ADMINISTR OR G< E E '• <br /> EA Gn N ro 0 N <br /> N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED v o v v o 0 <br /> fl v THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE fir�8 <br />