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Burnett County I <br /> Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator ( o0 <br /> ° <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> rn O <br /> N <br /> C <br /> OWNER <br /> 'I m + RV-4,N 1 `00A-JT2�– TELEPHONE CO L Z— –!Z6^ 1 O 37 v <br /> �� m O <br /> MAILINGADDRESS 5Q1� OLjUj�Y 141/6 S, MIj1 j L!; r yyrp 0LK j MA) 5Sy 1 r <br /> ?ML r l5q93O ADDRESSgdi5 CVryP Okvl�1- I ° <br /> f� +-ISN i5W 11 <br /> LEGAL DESCRIPTION(see tax receipt)j � jjAT f)F eCryyND pj�j(j IL2 (�L. I A/60V L M f t Z m <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE 9 ADDITION o= <br /> TYPE OFPERMIT(S): _a n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION 5. <br /> ❑ <br /> � T <br /> 7q o <br /> STRUCTURE/ADDITION USE: Q(4nS <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: /r r► z <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M Ci <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> �I v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). U) ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. 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. ° <br /> f � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI� E.AON€WEN v ° C <br /> r` ` H I DG <br /> NEEDED. ,�/� <br /> U v M V � ii! 1 Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P I <br /> CONDITIONS OF PERMIT: � , 1�� �a04 I� � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OP PERMIT L _ <br /> ISSUANCE. (�� ��pk��EC ! r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHQRELINE- COUNTY `O C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONING d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5Dd0mam <br /> 6. a mCyN ° <br /> Z � N ° J f0 <br /> 7. 9 T m <br /> =rni <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my f G)c i i ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of oI Y3 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o M <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 ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other w <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m m o <br /> CD <br /> SIGN HERE a <br /> (signature of owne&o6 building contractor) 1(datelQ <br /> ZONING ADMINIST TOR i .»vs <br /> ,is»�.rosn <br /> c �opa � oo d <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />