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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 /> _ r <br /> N O <br /> C <br /> OWNERTn V,V TELEPHONE <br /> O <br /> MAILINGADDRESS 306 1 :7 S3, 5 T F& n trt cSs'jS ;X, F <br /> r (D <br /> 0 <br /> PROPERTY ADDRESS PQ l C� Ln C) '3 ( y Y l, _ 06 :6, <br /> t <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CD <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ V I v <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION El <br /> N <br /> STRUCTURE/ADDITION USE: C Q 6 1n 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m (� <br /> v � <br /> [ F <br /> BUILDING CONTRACTOR: Se- <br /> CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE ORC <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O D J <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n J <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m -9 <br /> NORTH(N). (n J <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. 0 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <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. D <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q' <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. pQ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY — a <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> �ba.ek n�.�- <br /> 6. 1 �1�' l� rn ISIS+ b e S+01 �i��,zd 0 m m ° n T <br /> bQ y��^ m x3 am Fam A <br /> vv p m C y O <br /> C y N 0 O <br /> 7. �h I C" o TI : : ' m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° rn <br /> S <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 o, : 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. 'D : 0 <br /> -n : 4 <br /> c� ° D <br /> SIGN HERE —� �� (� to ' a E <br /> (signff�owner or bui ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> 1��1Npp <br /> TOWNSHIP PERMITS MAY BE REQUIRED O0000000 <br /> N U W W NrO <br /> TH-ft f-mMl`rH�A_ 1 EXPIRE ONE YEAR FROyI DATE�I$/'IAI�E i J 1' '3^�v <br />