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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator -V ci Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> II p N <br /> OWNER I Lo i10Ud �t N TELEPHONE S Cfv <br /> / <br /> m� <br /> MAILINGADDRESS� 8 (Qsd K �ye. ^ i qiALtL,,, O <br /> Tv`I 0 m <br /> PROPERTY ADDRESS K I <br /> LEGAL DESCRIPTION(see tax receipt) 1 csrgl vo!� P477 (T"L 3 1-3-- ala —/ u' <br /> DWELLINGBUILDING LrJ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ In o <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/G DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> N <br /> STRUCTURE/ADDITIDNUSE: O h l Pi <br /> [�(Hom�e//C�abbin;�C{ommercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: �j <br /> v w <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 V <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N !\ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n \� <br /> ?t oZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). U) UU o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF C' � 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. - u <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W IN R <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. F 1 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT199Nj %NEWHENNEEDED. v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> OctY <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER <br /> I <br /> 2. REMOVAL E <br /> OVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN .ISSUANCE. RNFJT <br /> 3. PO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 20N�N,V/Vl y O H <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER �YQ <br /> CSETBACK AREA. <br /> 5. l � C � <br /> CD mwc�i � oD.� m <br /> 6. m C y W <br /> 7 .Z W m o <br /> ° <br /> -n` ` m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m — =r Q <br /> Pp ( 9 Y ) Y Y C) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 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- <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 m <br /> providing in this app ation. I agree to permit county officials charged with administering county ordinances or other o <br /> m : co)E <br /> authorized person t ve ac to the above described premises at any reasonable time for the purpose of inspection. o , <br /> (D m <br /> SIGN HERE Z Z r+' <br /> signature f o er`or building c r) (date) `XJ ' n E <br /> i <br /> ZONING ADMINISTRATOR <br /> � 6:ul��N <br /> NOfN7, ro00 <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA�C <br />