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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 /> _ r <br /> w o <br /> N <br /> C <br /> L ( <br /> OWNER ��I LI V L��t h TELEPHONE � I j ��� ��40 o <br /> //� /�/ <br /> MAILING ADDRESS z �Z A45S L 9- 4 Ll 6dYI,hl(..�t� �Z 1 `4 d 3 1) C� O <br /> 7 <br /> PROPERTY ADDRESS Zglit�' F 9455 �� 1"� ry� (•U ) UO d <br /> oV 3 c3M d ►io w Q <br /> LEGAL DESCRIPTION(see tax receipt �- N 4 -� p C h a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> S�>•p3 L <br /> T. <br /> STRUCTURE/ADDITION USE: Ju1yl- uY j21 U f.� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> m <br /> IM�rs�l l� <br /> BUILDING CONTRACTOR: CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 1 <br /> O — <br /> ;V N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o � M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (n 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 12o <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. P <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS j --4 6 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o � <br /> NOTE: BUILDING/STRUCTURE 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: © a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY n` <br /> PERMITTED. �J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. MAK. S7aav-r�y uildT o L� , , _j1 2� 1 ��'�' <br /> /�Q mF wm DOnO <br /> Q " m <br /> 3 n6. /Y1 R-1 z y °o may <br /> � ° = 3 <br /> 7. Z cm � o c � 1 <br /> o m -nom <br /> = � [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m I C <br /> pP (including Yaccompanying ) g <br /> all information contained in this application Includin an schedule and 1 further declare that I recognize m c 0 <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- }Q�� ° rn <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am v d o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized per o o have access to above d scribed premises at any reasonable time for the purpose of inspection. ° a <br /> m <br /> D <br /> = �c - s _n <br /> SIGN HERE <br /> (sig ur of owner o uild' g contractor) (date) W o <br /> ZONING ADMINISTRATOR i <br /> O 69 EA N <br /> OO U O l O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OE ISSUANCE <br />