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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> F o <br /> N <br /> C _ <br /> fD W <br /> OWNER To�Vnj V JqI✓ TELEPHONE <br /> MAILINGADDRESS GIS-fVV0 of, Ltj /J , t'' rape 6yey—� 4,d <br /> PROPERTYADDRESS �c{�6S D C'o'n n IVZ- �St� <br /> N <br /> ( P © Loi 3 CSy. L 110 a <br /> LEGAL DESCRIPTION see tax receipt) m k cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION <br /> TYPE OF PERMIT(S): ❑ .S cn <br /> FILLING/GRADING ❑ CAMPI G UNIT [I SUBDIVISION Eln <br /> STRUCTURE/ADDITION USE: 4A'tA6j�,5710R�40 PL `7/ �C 3d 0 <br /> ( me/Cabin, Commercial Business; Bedroom; Deck; etc.) cn " <br /> C m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <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. t 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f W <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. Z ) <br /> CONDITIONS OF PERMIT: P <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> c) o0i nri 0 M a *m <br /> 6. <br /> a o m c y o 3 <br /> Z r- <br /> 7. vi o 1 <br /> o m -n � . <br /> = rnf E 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 G) � ; C <br /> knowledge and belief it is true, correct and complete. i acknowledge that I am responsible for the detail and accuracy of m <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- `D <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 d o <br /> providing In this application. I o rmit count officials charged with administering count ordinances or other �' <br /> P 9 � PP� Y 9 9 Y ? � E �CD—, <br /> authorized person to h ess ILo the a o e described premises at any reasonable time for the purpose of inspection. fD 'a <br /> q m y : <br /> SIGN HERE <br /> (signature of owner building contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> ,fin G�EA di fA�N <br /> a ►�q_ <br /> 11� GOV O NNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />