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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 ci Z <br /> CD 0 <br /> APPLICATION FOR LAND USE PERMITS . �I <br /> _ m W <br /> nn �� C <br /> OWNER Ro I\ ¢ -SU C � D"soy\ TELEPHONE ( 5 - - '7() 'g <br /> MAILING ADDRESS b I <br /> PROPERTY ADDRESS STUB rzh <br /> LEGAL DESCRIPTION(see tax receipt) WI ��/ 1 c //J 21a� J <br /> �l i 1 n <br /> ID <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® CO <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRAD <br /> I <br /> 'N <br /> 'G 1:1 CAMPING UNIT [:1 SUBDIVISION <br /> 11 ❑ n <br /> STRUCTURE/ADDITION USE: CC K, 1 �6 X I I D o J� <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: M`(s t t r- - RO 1-I --J-0 N )1 S O I �. <br /> in <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 812 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) p m <br /> m a <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. �• <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ) <br /> CONDITIONS OF PERMIT: V 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V <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 /> M0 W >O D o V <br /> 6. CD3 amx m � <br /> a m cy m o <br /> 7. Z v � O : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) O <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m Cc v, C <br /> i a : cn 70 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mt7 <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 w <br /> providing in this application. I agree to permit county officials charged qu rti�tering o t,,rclmances or other a ; <br /> authorized person to hav ess o the above described premises ata a_le xipi�f t se of inspection. m Cn <br /> o <br /> SIGN HERE <br /> signature of owner or building contractor) at�) a <br /> APR 2 6 20 <br /> — r <br /> ZONING ADMINISTRATOR I/Il <br /> IOU ted tv BURNETT <br /> N N N 00 <br /> �'ZUT�I, _I— WNSHIP PERMITS MAY BE REQUI <br /> ODNING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />