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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 /> o <br /> OWNER ✓/ ?h d( 4_Von TELEPHONE 6.5�-J3.S-7372 <br /> MAILINGADDRESS �� �u ch 1"o/n [ y✓. F G�Jo� <br /> p U o <br /> PROPERTYADDRESS 62y/ 10f'r/i4 '(a/lr )e/l/ <br /> LEGAL DESCRIPTION(see tax receipt) ,v C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ , �^ <br /> TYPE OF PERMIT(S): o- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 (, <br /> 0 VJ <br /> STRUCTURE/ADDITION USE: ,f3GA C- e - 1G.SS �&A y!I✓1 � <br /> me/Cabin; Commercial Business; Bedroom; Deck; etc.) c V <br /> BUILDING CONTRACTOR: a r <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/.X 11 SHEET OF PAPER. ANY INCOMPLETE ORT 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. <br /> m <br /> '-' v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (A ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDINGm <br /> S)TO Q} 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF1, Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 111,���rrrljjjJJJ W ° <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. o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <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. f <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. Si f r l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Y� t <br /> ISSUANCE. CI` <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. v V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. G <br /> 5. <br /> 77 to p M 0 M a E V <br /> N F 3 6 0 Ox n � p <br /> 6. o o� C y y 3 <br /> Z C N ry 0 O 1° <br /> N , <br /> T. O N T� m <br /> - n A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m a <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize '. ` : _ ; o <br /> PP (� 9 Y ) g m . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ` ` ,o <br /> authorized person to have acce the above described premises at any reasonableI <br /> D <br /> SIGN HERE n <br /> uE <br /> (si6niture of or building contractor) (date) ° <br /> ZONING ADMINISTRATOR NOV y°�{/° E <br /> 6N(�l,W W NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> BURNETT COUNTY " <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROJ� DATE OF I SU. <br /> 'Pejm7+-4- IRk4?/ fed tp Ll /�Q /,� <br />