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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> OWNER TrryY(aIGZ Jr( TELEPHONE <br /> [ m <br /> MAILINGADDRESS �fn Ma <br /> S r�r O <br /> d • r m <br /> 0 <br /> PROPERTY ADDRESS ` <br /> \1 <br /> LEGAL DESCRIPTION(see lax receipt) pe, �. L /7 <br /> ,LSI <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Ibl ADDITION 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTUREIADDITION USE: GPe,Pe,,,,4 <br /> Gf1 � <br /> `(Homme/Cabin; Commeraal Business; Bedroom; ; etc.) to <br /> m <br /> BUILDING CONTRACTOR: m <br /> � � r <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> -iD N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> -n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m '? <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. F <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. YQ� ry O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,a o <br /> pQ <br /> �`1 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 93a0 <br /> NEEDED. F <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z _ <br /> CONDITIONS OF PERMIT: P 1 j jI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. L-) <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 1J <br /> SETBACK AREA. <br /> 5. <br /> cm o0i m n 0n0 m <br /> 6. m 3 3 'a0 x �" �= A <br /> 0 m C Nj N O j 3 <br /> Z C fn m 0 O �O 1 <br /> 7. O <br /> (Jim T m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj 2 d+ O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <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 / m o <br /> providing in this application. I agree to permit co7r%, <br /> o icials charged with administering county ordinances or other <br /> bove <br /> authorized person to have access o the ades rt d premises at re on b <br /> a : <br /> / �// <br /> SIGN HERE ! % /L � � ` � o. <br /> (.Ana ow r uilding contractor (d e - a� i ' o <br /> ) I <br /> ZONING MI TRATOR AUG i) 2006 <br /> fA fR di fA N <br /> CIZ �ON O (Wn N (NT0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU N&PNING <br /> rrj7 * lir ( led -jo -refry , u I—y a <br />