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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 . <br /> y O <br /> OWNER (j Gt R,� q- E W A`-1w TELEPHONE Z l '3 <br /> MAILING ADDRESS ` )a / �l't T I G 1— j t/ �Nl.�S !t� tel/ //J'7 �f 13 O� <br /> i I <br /> 1 � � <br /> PROPERTY ADDRESSCW19II-le-tom& C� R�jL 1/C/ .o <br /> ` / r <br /> LEGAL DESCRIPTION(see tax receipt) L) L� 7�11 �CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ N <br /> TYPE OF PERMIT(S): px <br /> FILLING/GRADING CAMPING U,NIIT ❑ SUUBDIVISION' /❑ - 1p �j -�<• <br /> STRUCTURE/ADDITION USE: at7 / ,7 /l A lP� Uilat �Q aiPJL - <br /> (Home/Cabin; Commercial usiness; Bedroom; k;etc /�/f U G <br /> BUILDING CONTRACTOR: r Y ,tea? c,� �n l [a aU <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) CL <br /> 1\ <br /> ?l o� z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m � jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mNORTH m <br /> C C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rNn <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ti Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED LLED. t <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CTC.,THE PLANS 5 / <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI TION MAY B <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ev V / o ( ) <br /> CONDITIONS OF PERMIT: HIVF� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT IQA� pC0�/N / <br /> ISSUANCE. N11 V6 <br /> (n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. `�vJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> Sl7l` CK A$ZA. _ <br /> 5. (OVI� yam_ <br /> mmrDiga6. 3cLOw = sM <br /> fm <br /> OR <br /> Cy y o r+ <br /> 7. o A m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m �'• <br /> PP ( 9 Y ) Y Y C C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> v i a cn • M <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ': o <br /> authorize rson to have access to the ove described premises at any reasonable time for the purpose of inspection. m 0 ? o <br /> } m <br /> 0 <br /> SIGN HERE r ` o . a <br /> (sign ur of ner r bull Ing contractgr) (dat ) <br /> ZONING ADMINISTRATOR <br /> g "LnN"69 <br /> 8 <br /> N 001 U10 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />