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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator 10 07 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> N <br /> OWNER4ur TELEPHONE S-' <br /> MAILINGADDRESS � O <br /> 2P3Afi /yt L CCH=/ /<or ��cre©rimer tv <br /> ° <br /> PROPERTY ADDRESS 25/73 IIoLLsatJ� C./Ci-�/IJ �.sorfrY/ u/tt s �/Po� ` <br /> LEGAL DESCRIPTION(see tax receipt) Yj C <br /> S� %�9 R/y W Q 0_ <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION 1:1U) ° <br /> TYPE OF PERMIT(S): a <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �: <br /> STRUCTURE/ADDITION USE: �ey�OiN/� ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ( <br /> BUILDING CONTRACTOR: W07 t F ir/ L <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m p <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). tCn 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> a <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 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> O � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0— <br /> NEEDED.NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q' <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. P O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J C> <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X cid m 0 ( a : m <br /> 6. m x3 am Fnm ;a <br /> -o o m C 11 <br /> O ' in A <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c c <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of v °_ <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m (n l7 <br /> O <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 ° <br /> providing in this application. I agree W permit county officials charged with adrryi r' �9 or_other <br /> authorized person to have access to above described premises at any reas ICD <br /> f tle dp t n. -n Q <br /> LI) m D <br /> SIGN HERE <br /> ign re of w r or building contractor) DtL ? e 0 <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY C)8 N o o <br /> O N Ut W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING �✓ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />