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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> C <br /> d <br /> U.1 <br /> OWNER ! �if�1(�taLC.`� �'e' -- <br /> TELEPHONE <br /> lJr- 3�-1�(— Z371� o � ; <br /> �-� S Y ! CI.t te4A- Qbt�� t�(�j 1'it/S�� 0Z O <br /> C9 <br /> MAILING ADDRESS <br /> - r � <br /> O <br /> PROPERTY ADDRESS Sawe <br /> ( P) ��( GC�SC� ► r <br /> LEGAL DESCRIPTION see tax receipt) � <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITIONS' J C <br /> TYPE OF PERMIT(S): <br /> a <br /> FILLING <br /> / <br /> GR <br /> ADING ❑ CAMPING UNITI ❑ SUBDIVISION �,-NI 5 <br /> STRUCTURE/ADDITION USE: (` tO K l LI t -6�l toC l S o —� <br /> (� (Home/Cabin, Commercial Business; Bedroom, Deck; etc.) c <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 jJ <br /> T1 (, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O — IZI <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE O <br /> CNORTH p <br /> 3. SHOW D M)ENSIONS 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 O Z <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. n <br /> o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <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 <br /> ISSUANCE. C <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 W(Rd <br /> TER // <br /> 5. SETBACK <br /> AREA.� lie1 73O��` �'"` �ror and ,�IA'd §,k) <br /> m0 � Doavm <br /> m, x3 warn sam m <br /> s. proPer�t� �I ►. � 0 0No � 3 <br /> Z C N N O _ (n <br /> 7. o m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — ^ O <br /> pp ( 9 Y ) Y Y � � N C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of ( n 0 : T <br /> all information contained in this application (including any accompanying schedule) and I further declare that I recognize ! c m0 <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C>4cn <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the ahAve described premises at any reasonable time for the purpose of inspection. CD ia <br /> m : > : <br /> SIGN HERE <br /> (sig tur of own r b 'ding contractor) ( ate) O <br /> ZONING ADMINISTRATOR <br /> Efl'A Hi EA N <br /> n 0 r 0 n 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED i O o cn o o <br /> TH PE SHALL EXPIRE ONE EAR FROM�� <br /> tl G1 SSU /�cl by <br />