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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> — o <br /> N <br /> G <br /> N <br /> OWNER G��r � _s n Ste- •oT-a- ,,-1 Le✓n . TELEPHONE / 3 �n <br /> MAILING ADDRESS C T. ( w O <br /> PROPERTY ADDRESS Se<1 , Z .T '3r�i J� /�-� L,(J' <br /> 0� <br /> LEGAL DESCRIPTION DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Ial (n <br /> TYPE OF PERMIT(S): v �, <br /> FILLING/GRAD ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> 401 a <br /> ®,' � C-T% <br /> STRUCTUREIADDITIONOSE: A S" 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> m VJ <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY,X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M N _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cn o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m / TM 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v 1 1 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. C P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),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 N 91 <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. p„� o F D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: ` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 <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 C W 0 a v v <br /> 6. x3 <br /> v o7. <br /> Z c m o 1 <br /> m ' m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m � : O <br /> PP , 9 Y ) Y Y G) 2 � : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 1 n ^n, <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize � 7711 m c v <br /> v1 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 m <br /> G <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 l�XJy�� � d o : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m 'n <br /> r <br /> m D : <br /> n : <br /> SIGN HERE <br /> er or building contractor) (date) IJI h 0 <br /> ZONING ADMINISTRATO ure can <br /> C ONO (T U� UO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS-PERMIT SHALL EXPIRE ONE YEAR DATE OF <br />