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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 a <br /> s _ <br /> CS/-4Y7- P/Z/ g <br /> OWNER �Te4Yi c y dv✓Th <br /> n <br /> 0 <br /> MAILINGADDRESS <br /> PROPERTYADDRESS ,�y lDI /n en st A;-Q <br /> LEGAL DESCRIPTION(see tax receipt) u <br /> OWELLINGIBUILDING ❑ GARAGEIACCESSORY STRUCTURE X ABORTION ❑ W <br /> TYPE OF PERMIT(S): o <br /> FILLINGIGRADINNGG ❑' CAMPING UNIT [I SUBDIVISION F1 / 1 <br /> STRUCTURE/ADDITION USE: 1#iaF 1� Lr-�d lC�.+t,/ or.l / C\. <br /> (Home/Cabin; C menial Business; Betlroom; Deck; etc.) <br /> BUILDING CONTRACTOR: " LA <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN eY X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. µ� lc�- A <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) t/• 'SL O `ma <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(ES)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N V o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO an a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF i <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 1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. d <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. J IT\. 4- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> N\ _o s3 111lt�� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ?+ - IL <br /> NEEDED. it � ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONSQ PERMIT' 1 p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. (� V <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 /> 4. NO PERMITTED <br /> STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ` 1 C) <br /> SETBACK AREA. <br /> 5. <br /> A mu a � OA <br /> 6. _ x93 a.H 9,v <br /> cmcH . > > 3 <br /> /. Z = O n H <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 1- . or <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0, <br /> all Information contained In this application(including any accompanying schedule)and 1 further declare that I recognize $ an <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. m <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 <br /> authorized pe on have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGNHERE <br /> (s' tura or owner <br /> 1 building contractor) (date) ! 8 <br /> ZONING ADMINISTRATOR �(Qn� /� ppp <br /> �ONONNNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> TjjIS PERMIT SHALL EXPIRE ONE YEAR FRP F ISSU CE <br /> mi� � ISIPickeduP H a _ amen <br />