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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator -0 Q o <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER l! J TELEPI-IONE✓Ca ` v <br /> w <br /> m <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS ,( <br /> c— I <br /> LEGAL DESCRIPTION(see tax receip C2 0—q6 / i <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n O <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADI G ❑ CAMP/Gy UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: <br /> Home abin; Commercial Bul�ess; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 42�77(� / <br /> 4 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M y G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 71 O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W Z00 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ? <br /> (� l 0 <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1�7- N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS ! 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. rj 0 of <br /> W o M -j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIUj <br /> q g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. QpR Z <br /> 2 0 I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT -7T ®�c l <br /> ISSUANCE. 2O /V y� W G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'Vf'Iv� r ] W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY - C <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. �3 CL CD X <br /> a m C y O j <br /> 7. Z N O O q <br /> O M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — Q <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 @ N <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize �: m m O M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G): <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 E w <br /> providing in this application. I agree perm t county officials charged with administering county ordinances or other <br /> i m (n <br /> authorized person to have access to a abov described premises at any reasonable time for the urpose of inspectio . c <br /> (D CD <br /> SIGN HERE , � �' <br /> (signature of owner or building contr ctor) (date) n i <br /> ZONING ADMINISTRATOR ( �a <br /> -. '• in to <br /> EA f9 fA fA- N <br /> i UIOUt BOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />