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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> K Ir. r <br /> O ((�� /� c o <br /> OWNER 1r �/ �P P`OP el die rn L TELEPHONE /J J 7/!� ' 019/�/� n V <br /> 0 <br /> MAILING ADDRESS � V�� ��fe� � � C;�,,..,,��, „tom- Cj ) � O <br /> PROPERTY ADDRESS IN ead 01A) Wye J/'e'� <br /> /� VC Sic �( � <br /> LEGAL DESCRIPTION(see tax receipt) Cp do C�PL�/� �c�e�"�yQ��,y C n <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING K GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El (n °0 <br /> �� <br /> FILLING/GRADING 11 CAMPINGUNIT El SUBDIVISION Eln <br /> STRUCTURE/ADDITION USE: r /Or r`,e Cp i o 9 <br /> (Home/Cabi Co/m`mercial Business, Bedroom; Deck; etc.) (n (1�1 <br /> BUILDING CONTRACTOR: P . Cl( e ()rope-1-1 Y � <br /> mIro <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR N <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TI <br /> O - <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O <br /> 'r1 0 <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). c n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <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. z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. o <br /> J v l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o0 o <br /> NEEDED. <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 0 <br /> SETBACK AREA. <br /> 5. <br /> M m M W 0 <br /> 6. M �' D <br /> Em <br /> m � 0 am Fnm <br /> 7. a O ce c y N o > T+ <br /> Z C y O O O <br /> 0 �,� : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofw' c <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> t <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m : rn <br /> sue a permit. I further accept all liability which may be a result of the Cou r r iG) : = : <br /> on I am m o <br /> providing in this application. I agree to permit county officials charged wji It 1 o d a r other i <br /> authorized person to have access to the above described premises at any rp ection. ff <br /> /�/ m <br /> CDa <br /> l 7 ^� a <br /> CD <br /> SIGN HERE ��� �- a <br /> (signature of owner or building contractor) *4 late) o <br /> ZONING ADMINISTRATOR <br /> BURNE1 1 fCOUNTYiv vi <br /> ON (n W W O <br /> TOWNSHIP PERMITS MAY BE REZONING <br /> QUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROADATE OF ISSUANCE <br /> �ermit I'f'k�� IPd' -bDKyle f le(-ce, S-)-oG- <br />