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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o Z <br /> APPLICATION FOR LAND USE PERMITS - <br /> 0 <br /> N <br /> C <br /> 7/s <br /> OWNER A J � /� '-CIXVIPJ TELEPHONE <br /> MAILING ADDRESS � <br /> PROPERTY ADDRESS C< <br /> ( P) OTe� f a s -Tbu)" SAO R .�/s iJ NE JE <br /> LEGAL DESCRIPTION see tax recei t <br /> y-� 1 J <br /> DWELLING/BUILDING V—GARAGE/ACCESSORY STRUCTURE U ADDITION IJ S J <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: <br /> fl Me <br /> (Home/Cabin; Commercial Business, Bedroom, Deck, etc.) N <br /> BUILDING CONTRACTOR: \— <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61A X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> c O <br /> O C <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) T 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 $rn �. n <br /> c <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDINGS)TO m z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ( o <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 :E � <br /> BUILDINGS, ROADS, LAKE,LOT LINES. N p s <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS C 2�. --I _I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o T <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° Q� <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: O <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <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 ✓ Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. x7 to a0a0 -0 <br /> o � m � oco. � m <br /> m x 3 a m x �, = K <br /> 6. O m 3 <br /> C N i 0 <br /> C N N O : O 0 <br /> P m T m <br /> 7. <br /> va : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m� ; m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> m' o : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o o <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other [ ro <br /> m T <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m n <br /> j� a <br /> SIGN HERE � <br /> (sign of owner or building contractor) (date) i <br /> ZONING ADMINISTRATOR ) <br /> O N O N U f n 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> TNS PERMIT SHALL EXPIRE ONE YEAR FRO�r.I DATE OF ISSUANCE <br /> P`ermt:�+ LQ.ber-�1 .— (Yk 7�nn <br />