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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CID 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 1— <br /> OWNER <br /> OWNER 'S4W /¢y1 l (J&A CX l r/ TELEPHONE �z !/ o <br /> p m <br /> MAILINGADDRESS �g� [ D04 VX- CD <br /> � F <br /> CD <br /> � n / � nA 0 <br /> PROPERTY ADDRESS q f �/ — hYY In I t (� 1 0 <br /> LEGAL DESCRIPTION(see tax receipt) 0 Cn <br /> m <br /> DWELLING/BUILDING o <br /> TYPE OF PERMIT(S): _ y <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ (�/ /�'Q o. <br /> ✓✓ <br /> Fn' <br /> STRUCTURE/ADDITION USE: /K a o' <br /> (Home/Cabin; Commercial Busine s; Bedroom; Deck; etc.) �n <br /> �o u GoM�S <br /> BUILDING CONTRACTOR: <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> In o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS 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 <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. ) y * Q <br /> 5. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a. o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p0 GO <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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 /> M a)m m D 0 a 0 M <br /> f m <br /> 6. B a a m <br /> 'o omCymo � 3 <br /> 7. Z c 00 CID <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — ^ : En: A <br /> PP (� 9 Y ) Y Y � � <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o, C <br /> � : <br /> _ : : <br /> M 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn : G <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 0 o <br /> providing in this application. I agree to permit county officials charged with admin' m <br /> authorized person have acc s to the above d s ribed pre ises at reasonab i h m <br /> T : : <br /> ILA m > : <br /> SIGN HERE / i ' a <br /> (si nature of ownbCro//r��buildi contractor) JUN 2(J <br /> ZONING ADMINISTRATOR im lan <br /> <n t»to <br /> BURNETT COUNTY <br /> O N V W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIREDZONING <br /> L YEAFmy 6C , �{ /-� <br /> THIS PERMIT <br /> SHALL1 EXPIRE ONE <br /> R�n� A am EUb-wgI(ar to /(4�5 <br />