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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N <br /> OWNER L�d a l� d'— ^e /\ GI C l / " 1//CrTELEPHONE -71S-66-6-- 837C) c^pr r v7�, <br /> / ) 4V87,3 <br /> m '0" 1 <br /> MAILING ADDRESS 7 a ! F,'r �r 6 ST!✓_ �� 4V 873 f <br /> �^1 o (� m <br /> PROPERTY ADDRESS v�8 9! Q rU Ro R � <br /> LEGAL DESCRIPTION(see tax receipt) /[�[�jj s�j s� Siv� Stt�v T410;4111 V. <br /> \ m <br /> DWELLING/BUILDING tK GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (n o0 <br /> TYPE OF PERMIT(S): < <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONOSE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) Co <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 37 C r� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m (95� �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m -30 <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. <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. QJ <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 �, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA O A BE <br /> -BE DONE WHEN ° ONEEDED. iul\/(THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. va <br /> o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P MIT AUC 1 q <br /> ISSUANCE. p �^ W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORAW&VE77 CC <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �ON�NG UIV7 y <br /> PER4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m WMM0vavv <br /> 0 3 'am <br /> _5 <br /> 6. <br /> v' C <br /> my ,y > > <br /> y O <br /> 7. n i 111 <br /> =rni E O <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. I acknowledge that I am responsible for the detail and accuracy of a a N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �; m o C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- Lam; ; <br /> sue a permit. 1 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 agre to permit county officials charged with administering county ordinances or other m <br /> m : rn <br /> authorized person to ve access Inspection.he above described premises at any reasonable time for the purpose of Inspeo <br /> y m <br /> SIGN HERE 1 w <br /> Lure of owner or I ng contractor) (date) n <br /> ZONING ADMINISTRATOR <br /> I S � � l.f tNi �O" tNi C <br /> OWNSHIP PERMITS MAY BE REQUIRED VV <br /> '�D THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />