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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administratorm o c <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> y O <br /> N <br /> C <br /> /^ d <br /> OWNER TELEPHONE 8llc y <br /> MAILING ADDRESS <br /> zW i <br /> � A <br /> PROPERTY ADDRESS <br /> __e"f <br /> LEGAL DESCRIPTION(see tax receipt) C ,JJ 5 �� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE V1 ADDITION ❑ lb <br /> y O <br /> TYPE OF PERMIT(S): O <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o <br /> STRUCTURE/ADDITION USE: f-a'`- 1�1 0 <br /> (Homee//Caabbin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: � � 4 _JOVrj l(o <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/.X 11 SHEET OF PAPER. ANY INCOMPLETE OR r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 31 y73 /} <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 (D \l <br /> in <br /> ?� O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o6- 0 <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 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 I C- <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 9 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N S <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' O <br /> v_ 0 <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: I (Z <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <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 <br /> SETBACK AREA. <br /> 5. <br /> 8 S. D' 8am >> <br /> 6. m m O <br /> (D C y �W O j <br /> 7. y O O O <br /> Z <br /> 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 p : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : En, <br /> CL^ : (n : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m G me <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 I' bility which may be a result of the Cou j�relyngIon this information I am m <br /> providing in thi plication. I a e to permit county officials charged i is a es or other i <br /> m : rnE <br /> authorized per n o h ve access the above describe premises ata f t nspection. c <br /> a m <br /> Au ltm SIGN HERE 1 69 <br /> sig ure of owner or building tractor) G ' 2 (d �) ` a i <br /> ZONING ADMINISTRATOR ` ' ry/ •IS <br /> ' <br /> _ V N 1 r ///,,1 (A M fA <br /> ro O N <br /> 7ON'ING XY 00 CCj, 00p <br /> TOWNSHIP PERMITS MAY BE REQUIRED �. <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />