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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 /> N O Oa <br /> c <br /> a �l <br /> OWNERWL /74 / ( TELEPHONE �j 3- � o �✓ <br /> m ° <br /> MAILING ADDRESS ///,690 <br /> / 0 <br /> PROPERTYADDRESS 39* <br /> LEGAL DESCRIPTION(see tax receipt)6,, <br /> d <br /> �J, ,i.of -yob .Srfge <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Cn <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT X SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: tb l llz 1-I n l t <br /> ( me/Cabin;Commercial Business; edroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N o <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)OFZ <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 <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 o -(Z'MUST BE SIGNED AND DATED BY THE OWNER. n <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. "» <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT UJ <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 a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD mmr, mcF m <br /> 6. <br /> m C100 N O j C <br /> Z N 0 q <br /> 7. 9 ; m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —r^ D <br /> PP ( 9 Y ) Y Y � C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w vi <br /> i a0 <n • <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o me <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- <br /> G7: <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> m : m: <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m o <br /> Y�11'a7 -dy m <br /> SIGN HERE 7 a <br /> re of owner or buildl g contractor) (date) Xp) <br /> v : E <br /> ZONING ADMINISTRATOR <br /> ro <br /> M 0(A fA0 N <br /> NONCNn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED V <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />