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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> F O <br /> � � y <br /> OWNER W f m \ O�--l�Q Y\/ TELEPHONE <br /> o V1 <br /> MAILING ADDRESS a 5� j 51- 1U I�k M N 553�y O <br /> PROPERTYADDRESS Ol /�O� U(AmiSU/V R(� Q � <br /> JLEGAL DESCRIPTION(see tax receipt) C <br /> J / 2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ r- <br /> STRUCTURE/ADDITION USE: S_�tile 15:4MJn .QJ(Xlk $r a S�Of y <br /> (Hom Cabin; Comme al Business; Bedroom; De k; etc.) <br /> Cn <br /> BUILDING CONTRACTOR: 7Z- <br /> L U <br /> -U Z O <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> > <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 C <br /> O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> O a r <br /> n \ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 0 <br /> NORTH(N). <br /> m <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 a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. I - <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SU <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I 0 Q> <br /> MUST BE SIGNED AND DATED BY THE OWNER. '- <br /> o-4o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o r <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: Co D <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> lV �. <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 /> 6. <br /> W0 r > 0Qov <br /> � Dnmxa � M <br /> 7. Z C N 0 N O �O <br /> � : Tom : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m 0 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m cn : c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize F <br /> ' m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m ito 0 <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am ' `. a! o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ha ccess to the ab ve described premises at any reas a p tion. <br /> CD <br /> -na <br /> SIGN HERE ` D <br /> gnat a of own building contractor) (date) I p' <br /> l <br /> 7.Ji i i <br /> ZONING ADMINISTRATOR �� 12WE <br /> G <br /> -+EA 69 Vi fR N <br /> TOWNSHIP PERMITS MAY BE REQUIREOURNETT COUNTY C N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS <br /> �l,,,, <br /> f U.l I U d -&ect,r-u{Dn <br />