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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T 6 Z <br /> APPLICATION FOR LAND USE PERMITS 1 o <br /> 0 <br /> OWNER TELEPHONE S [��� el�-SW a' <br /> o <br /> J / m _ <br /> MAILINGADDRESS / S 1 S� �f rl / / �fe�j 0 <br /> PROPERTYADDRESS �G� xt_ wlJt�� t /A /7 2 <br /> J` <br /> Lei :?ru8 7 S �/ 7yc /? <br /> LEGAL DESCRIPTION(see tax receipt) _ _ c3 7 _ <br /> ( _ <br /> TYPE OF PERMIT(S): <br /> �j11 ✓ 3 c S'5' � �' � <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ p' <br /> / f <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ v <br /> STRUCTURE/ADDITION USE: C o <br /> (Home/Cabin; Commercial Business; Bedroom; eck; etc. ' 41 J <br /> d C <br /> BUILDING CONTRACTOR: 5i-hf- — <br /> H 0" <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> O N <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) <br /> O a v1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T'n ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE O <br /> m m <br /> NORTH(N). m <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 J �'O <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN d <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 QJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. .Q�, <br /> 41 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ` / <br /> CONDITIONS OF PERMIT: o <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 w <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AR A. Q <br /> 5. SP) - <br /> CD a F m <br /> , 7. <br /> Z C 41 O t0 <br /> m m <br /> Tom : : : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of - C' n O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracymy of �' G C <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- �; CD 0 <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 m o <br /> providing in this applicati n. I agree to permit ounty officials charged with administering count ordi v m <br /> authorized person to h access to the above escribed premises at any reasonable time r m 6 <br /> a ; <br /> SIGN HERE D i <br /> J,' <br /> ign ture o or building contractor) I (dnaate) ? p [ <br /> ZONING ADMINISTRATOR C 2004 <br /> p'7331 SephC -r . <br /> SEA fA[A fA�N <br /> TOWNSHIP PERMITS MAYBE REQUIRED ' COUNT°' D O N u, w w N O <br /> O OION W NO <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANC �NIN� <br />