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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 (^1 <br /> OWNERv '�/DJ TELEPHONE7/.y � <br /> MAILINGADDRESS 5 `'t" L3 Ll�L S, --r A. (— Pf4N puf&j <br /> PROPERTYADDRESS C V4rj AA RlV ERflaE ef-74TOF.F <br /> t <br /> /q LEGAL DESCRIPTION(see tax receipt) W L IAJ - C' K' N W — OJy J m <br /> T A <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ to <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: (� Q'"r pqI I 0 <br /> (Home/C"; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: SE L F <br /> d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 7h <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 27 �O A ,,- <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <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 i n 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF �J� 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 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2. o <br /> o � ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a Q (r <br /> NEEDED. n " ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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. CA <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININr WAI I c FTr. AI I nwpn WITHIN THF RFh1 IIRFn WATER <br /> SETBACK AREA. This structure t0 be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> A co O r D O DOS <br /> habitation. ,a q d d 0 N o. f M <br /> 5. m ,°- 3 nm 0a , <br /> a p m C N . o = 3 <br /> 7. Z c H <br /> 0 i m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — p <br /> PP ( 9 Y ) Y Y G) c i C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of [ m n : u+ <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m E E [ E m <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 liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o <br /> authorized person It%4@Xe access to the aItovii0eperibed premises at any reasona le <br /> TI a <br /> a <br /> SIGN HERE u+ [ E a <br /> ( gnatur of ow r or I contractor) (date) o <br /> � E <br /> ZONING ADMINISTRATOR NOV <br /> Lj <br /> » n w <br /> 69 fA 69 fA- N <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> BURNETT COUNTY r S N N N <br /> TH PERMIT SHALL EXPIRE YEAR FROM DATE OF ISS INN <br />