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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS Z <br /> Cb <br /> 4/�1�'S C�4 r1 <br /> ONMER TELEF'FIONE <br /> , // <br /> � Q <br /> MAILING ADDRESS ��75I � d4�� �� � �L/� '000N <br /> PROPERTY ADDRESS Q� <br /> • t�/ n � a <br /> LEGAL DESCRIPTION(see tax receipt) L � / CS� VO���� J3� T 7 „��� <br /> DWELLING/BUILDING Q0 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 = <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> H <br /> STRUCTURE/ADDITION USE: C'$4/� 0 <br /> n <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) 0 <br /> BUILDING CONTRACTOR: CS�GY �G7�'�1 /�/QLCLC Oh7D S�1Y' <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 C C <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> '—t o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C T <br /> O <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 -.I,- Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 11 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 1-+ <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> l7 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q A! <br /> NEEDED. !' <br /> 7 _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �— UI I o <br /> CONDITIONS <br /> ONDRIO WAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF F� RMIT JUN 2 1 2 �O� <br /> ISSUANCE. V 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORBIRNETT COUNTY <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONING <br /> 1 O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. 9ShETSBArCK A_REA. <br /> U�S eS��: ` <br /> J Dw m o f m <br /> A3 =ai; x- afD M <br /> �o�I � tk1�Z �s JOI z y � oy =tea <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — - : i 0 <br /> PP (� 9 Y ) Y Y � w �� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of V` MCL o E <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize �E ' m <br /> ! , . � : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 'I' <br /> 64 <br /> L7 <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 ro <br /> providing in this a ti agree ermit county officials charged with administering county ordinances or other p1 <br /> authorized persqx10 h acce to m a bove described premises at any reasonable time for the purpose of inspection. o , <br /> SIGN HERE n <br /> (signature o ner or building co r ctor) (date) �✓ <br /> ZONING AD ISTRATOR I f O '• <br /> S) 10 <br /> �d TOWNSHIP PERMITS MAY BE REQUIRED Mt r e N o IBI }�uo <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ) <br /> N <br />