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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _ o° o <br /> APPLICATION FOR LAND USE PERMITS7 V-50. <br /> �j 11 ry f� N <br /> OWNER: 4411 4 IZ Z.4��W TELEPHONE �,3Q— S��3 —ZI V/ p <br /> MAILING ADDRESS �} /V/epi�G f?j�� fPO &0/7.2 m O <br /> CDCD <br /> 0 <br /> 0 <br /> PROPERTY ADDRESS <br /> SO <br /> LEGAL DESCRIPTION see tax receipt) V. o q O <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTUREK ADDITION ❑ cn G <br /> TYPE OFPERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: %a�'A 4 — /n/si�F ^�J <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) C Ui <br /> BUILDING CONTRACTOR: �`�'L F m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81k X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p — <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). U) 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 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 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 0 <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 q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o j <br /> CONDITIONS OF PERMIT: V <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY U <br /> PERMITTED. <br /> 4. jDING.F)FT?�II�IAIG 1NALLS,EIG. W4iMi}Nt Tf (iEQUIRED WATER <br /> BACK AREA. <br /> E, 7';�IfR 10ROAe e y uJ�z, A/o- 6e �Lo 010 ess 77e 6ARAf e <br /> C o � DVDvv <br /> I s �.1-�odeD �R MfIDC Coy/FORMi�/Gj. m 3 a F a <br /> Mco,0 <br /> y CDN <br /> ° n ` m <br /> =ld <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 113N: G1 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W m 0 vi <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize �' C ; E o m <br /> PP ( 9 Y ) 9 J m , E G <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 plication. I agree to permit county officials charged with administering county ordinances or other to <br /> authorized per n have access to the d ribed premises at any reasonable time for the purpo of inspection. m : : oCD <br /> : <br /> SIGN HERE �� 3 <br /> n ure of n or building contractor) (date) ( n <br /> ' V1, <br /> ZONING ADMINISTRATOR c ly <br /> fA fA fA�N <br /> N (n NOO <br /> U <br /> TOWNSHIP PERMITS MAY BE REQUIRED U O O O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />