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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 I. <br /> r <br /> N 0 <br /> N /L <br /> �^ / C <br /> OWNER iGf K � / I' �6 / TELEPHONE%fi^l(� 'ft <br /> MAILING ADDRESS / I i <br /> (��(o �-h<�hl�nd�r ��- �g�✓��s�cL� <br /> 7 <br /> G� 0 � � <br /> PROPERTY ADDRESS *19 <br /> qao(0 2 /' <br /> LEGAL DESCRIPTION(see tax receipt) CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OFPERMIT(S): (n <br /> FSIELL:INGDING ❑ CA XNIT El SUBDIVISION ElSTRUCTURE/ADDITIONU �r«�_ &.40 /)OX �U aN <br /> ( .ome/Cabin;CCoommercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> .G y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN 70 SCALE. '—I o Z <br /> m m D <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 Z <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. <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MA},_ DONE WHEN o <br /> NEEDED. ; j�/ /�� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ` <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF FERMI 444y ! kJ <br /> 2. R MOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ne v I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONCOU/V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INC UDIN RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER IN 7-Y <br /> �E,BACK ARE <br /> 5. Y-a/ <br /> l D mm2maf m <br /> 6. 3 am xnfD <br /> �N C <br /> 7. Z y (OD <br /> O T`G 1J <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —ct � 0 <br /> PP (� 9 Y ) Y Y �j� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E» <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E I. o ': 0 <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 /> authorized person to ve access to th bove described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> (signs re of o or building contractor (date) a <br /> ZONING ADMINISTRATOR C <br /> N(ZJ 1 ro 0 0 <br /> (n 0 0100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> X2125 STHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> 1 <br />