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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O iN <br /> C <br /> OWNER YlIKQet< �• Ci42otE�. �EZd17i¢� TELEPHONE 7/S- 6f&w" <br /> V/dZ 2 oV (�a 0 <br /> MAILINGADDRESS �7�A0 "s�tX,1S o -f <br /> � <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION see tax receipt) -r <br /> 12 <br /> DWELLING/BUILDING ❑ G <br /> �A <br /> RAGE/ACCESSORY STRUCTURE W ADDITION ❑ rn <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ (���� <br /> W <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m I , <br /> m <br /> BUILDING CONTRACTOR: <br /> SEL F <br /> v <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6/ T <br /> X 11 SHEET OF PAPER. ANY INCOMPLETE OR T3.O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> rZt Vl <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 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 _ 3 <br /> 3 .SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m r a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO rte. O <br /> BUILDINGS,ROADS, LAKE, LOT LINES. v <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N a <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. <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o a <br /> 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 61 <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. fy, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 00 <br /> PERMITTED. V" <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC_. ALI.OWFn WITHIN THF Pro ilIRFn WATER <br /> SETBACK AREA. This structure to be Used as private residential <br /> 5. fYl ULS4-ry + M mun UM garage/storage only. Not to be used for human <br /> X7 m(7r DOD O -U <br /> 6. <br /> 56+60ks -From IA -C habitation. m C m m 0 M a f m <br /> o W> > n n a m <br /> m �c n m �c <br /> anit sl-aL Ito 11rLt - o m C7. 8 = 3 <br /> Z = D � <br /> I declare that this application (including an accompanyingscneauie nas Dean examineo b me and to the best of m �^I D <br /> PP ( 9 Y 1 Y Y G1 C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m mo <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G 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 E o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso o ave access to the above describedi0mises at any reasonable time for the purpose of inspection. <br /> T : <br /> J N � Q <br /> SIGN HERE �( 5 �P E <br /> en a <br /> (signature of owner d m contractor) (date) rr'',, <br /> ZONING ADMINISTRATOR ! ��n�vW`n <br /> �fA fA fA fR�N <br /> ry ON(T W W NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED V ONO n N n O <br /> J.HIS PERMIT SHA4L EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> V m I-1 + t*+�( ma ►Vd+0 pa.r re4( N t11),`� ({-11-D h <br />