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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator M c o <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> C <br /> m <br /> ` ` a <br /> OWNER V,r GI 0.n �wr:L �.�, TELEPHONE -71 S <br /> m <br /> m <br /> u <br /> MAILING ADDRESS Q W [ Vii <br /> rCT <br /> m <br /> � ►ied S1 wsul 2� J <br /> PROPERTY ADDRESS <br /> Y"1 01-3 <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) u34 <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ m <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> S. <br /> STRUCTURE/ADDITION USE: r,L 0 , <br /> ([n 1 L D(Home/Cabin; Commercial Business; edroom; Deck; etc.) <br /> Gh <br /> BUILDING CONTRACTOR: ,to bt^1 T 2w� <br /> 0 <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. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> '—t O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m33 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y <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 Z <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. <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 0 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o F <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> 3. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ^�," <br /> CONDITIONS OF PERMIT: 7U SLJ I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <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. ors 1 ,g �L� �JC7C�kJC� }� �'Ki l"l� <br /> V 1 1J l lam/ / A 0r'> 0 10 0 Aq(*6. m 3 PLO m H 7. Za ." ` I <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m y: 0 <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 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E a m C <br /> i <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 m <br /> : to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mo : <br /> mi <br /> SIGN HERE <br /> gnature�ner or building contractor) (date) p�w^ <br /> ZONING ADMINISTRATOR V � � J L7ii <br /> e Ul O71 (!� O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />