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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator M o o <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> G <br /> OWNER TELEPHON�E.,c.7�/ S -(., jS -c� Z O Og- <br /> MAILINGADDRESS I�1Z1 �U <br /> S� m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) Z qy _/y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE R ADDITION ❑ o. <br /> TYPE OF PERMIT(S): c <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITIONUSE: �lc� R�� ga X 10 U ' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: I t 51�lF I� Cl <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> 7) N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> -n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 9 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> U) o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m — -o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. ➢J <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 0• <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS o GIO <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O 7 <br /> 1 O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN r. <br /> NEEDED. j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> Z Cx <br /> CONDITIONS OF PERMIT: �, t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �+ <br /> ISSUANCE. (U�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 <br /> SE�5. jBACK )AREA. C Ci <br /> I p In GLC2, Y `L l OD 3 R m Or a g M <br /> 6. C�•G <br /> (.lX —� v Wimpy � :q <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my Lj 2 : ; : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a c u <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize p 1 m C <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 <br /> m . <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m : rn: <br /> authorized person to hav ess to b e described premises at any reasonable time for the purpose of inspection. o <br /> m <br /> m m : <br /> m <br /> SIGN HERE <br /> (sinature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> V!fA N fA�N <br /> G (NT O a", (N11 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �Vf <br /> CruTrt.¢ti THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> 5-1x8 /oy <br />