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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> N o <br /> N <br /> C <br /> �� N <br /> OWNER Log TELEPHONE <br /> m W <br /> 49a I O <br /> MAILINGADDRESS �1 V'\ )lo' I� y1,.1� - UT f^c/Cjq <br /> 1 IJ�� J TO/ o <br /> Z Q �r m <br /> PROPERTY ADDRESS __.J I 2h� h <br /> 5��. �� � ) dd5fcc U it o <br /> /C 1 <br /> LEGAL DESCRIPTION(see tax receipt) f1 �-S o%? 15.5 17s�& 3 �� � � <br /> DWELLING/BUILDING GA AGE/A CESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): ti 0 <br /> FILLING/G ADING ❑ CAMPING UNIT ❑ SUBDIVISION F'/p �/'e q / a <br /> r7 a y (�� <br /> STRUCTURE/ADDITIONUSE: ��, 'P/ 1_J._ (,, /C7 `�60 0 <br /> (Home/Cabin; Commercial <br /> n <br /> ( m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPEv <br /> R. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n i <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 m <br /> O `m <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r ~ Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O A <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 ��3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 p <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. __(r, 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. ' <br /> QQ E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN + o <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P �J'I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT YJ O <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ( J(A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 V Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m cmm ori n 0Dn O <br /> F m <br /> x=— A <br /> 7. �^ O m C N N <br /> Z C O > 3 <br /> t1i ry 0 <br /> P iD T`G ZI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I - �' ` , : A C <br /> O'c i v : <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information 4,nedplication (including any accompanying schedule)and I further declare that I recognize m <br /> that this inform will be relied upon by the County of Burnett Wisconsin in determining whether to is. <br /> sue a permit. I bility which may be a result of the County of Burnett relying on this information I am v : o <br /> providing in tha to permit county officials charged with ado hauthorized perthe above described premises at any reason r s i oSIGN HERE aru�of(o'wlner or building contractor) I]C I ,dC ?ZONINGAD INI / J t� L��l {'� OCT J <br /> BUR <br /> COUNT- _O N N IBJ W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING o u O a v u o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DgTE OF ISSUANCE <br /> d-c,lmt�- �-12�1ei rn�c�lef,�l �j �h�, C�hl(d� 1S-�l-off <br />