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Burnett County 7410 Co. Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator M 0 0 <br /> APPLICATION FOR LAND USE PERMITS .CDf <br /> n N _ <br /> CL <br /> OWNER r\&A C TELEPHONE o2 q <br /> MAILING ADDRESS�(� $D IS� ' � I le `(/ `� Q <br /> r <br /> 0 <br /> PROPERTY ADDRESS C� % DV <br /> A A\bk +✓u J�S M <br /> 'L 1 r <br /> �EGAL DESCRIPTION(see tax receipt) 5. l4 * qd /�-1,7 /�7 � �/y i�7 pqj �) � <br /> DWELLING/BUILDING 1:1GARAGEIACCESSORY STRUCTURE El ADDITION 1:1 /_ rn O <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: 000 I X d d IV <br /> O / � r 764, / / U r /C/ 0 <br /> (Home/Cabin; Commercial Busin ; Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 Q <br /> CL <br /> ?I v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m I <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. 9 <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 R ILLED. Pl <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CQ f� ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. Ste, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFITION MAY Bt-DoNE <br /> NEEDED. ✓� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. L9 q `� c O <br /> CONDITIONS OF PERMIT: UA��} IQQf % C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITZ ' / C <br /> ISSUANCE. oN/NG L Q <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 <br /> CD <br /> 6. m 3 as � = R M <br /> CD y <br /> 7. <br /> p <br /> TI <br /> =c�€ J m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c' : C) <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of a ; <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize Q , m 1 G <br /> v E C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- a CD <br /> 17 <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 o <br /> m : rnl <br /> authorized person to haveaccess to the above described premises at any reasonable time for the purpose of Inspection. o <br /> m � m <br /> SIGN HER .O 46 E E <br /> (signature of owne r building contractor) (date) <br /> C S E <br /> ZONING ADMINISTRATO /��' '• <br /> � " E9 fA�• N <br /> 1--)19TOWNSHIP PERMITS MAY BE REQUIRED C G N c <br /> THISRMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE (" 0 <br />