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—o <br /> Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator - o� ' o <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> y O <br /> 2 C <br /> OWNER >✓Y) of TELEPHONE 6��6--✓ Y�� d �- <br /> MAILING ADDRESSoD <br /> t LUQ � <br /> t o m <br /> PROPERTY ADDRESS S Q � <br /> y sIIc/�5j4/31� <br /> LEGAL DESCRIPTION(see tax receipt) N Sq 5(,j,5 Ir. [)f c'�2�5 c✓C Q�l I m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 0 ADDITION ❑ (n ° <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING CAM/P;IN�G,,UNIT 1:1 SUBDIVISION ❑ 2' <br /> STRUCTURE/ADDITION USE: 7 Y-' a� X y8 `fix 3� ° <br /> ° <br /> (Hom abin; Commercial Business; Bedroom; Deck;etc.) w <br /> BUILDING CONTRACTOR: CD <br /> O <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p !!, <br /> 31 N 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> ?f v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m: b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). U) 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <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 N <br /> -40 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ) �0 ° <br /> 16 1 � � � o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI ATION N� 0 o <br /> NEEDED. \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. JVN 2 8 /l ' ° <br /> Z <br /> CONDITIONS OF PERMIT: Q / N <br /> U <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT CpV f V <br /> ISSUANCE. ZON/N Nr I d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N <br /> PERMITTED. _ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential =1 n r a v a F v <br /> 6 garage/storage only. Not to be used for human 2 3 a g 2 n * m <br /> habitation. z C o a <br /> 7. N <br /> 21 m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —� : D <br /> PP (� 9 Y ) Y Y � L7� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � m ° C <br /> ° c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O m � : $ C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is ?J <br /> Q O. <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 application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> �l�ocCD <br /> SIGN HERE <br /> nat�f owner or building contractor) (date) <br /> ZONING ADMINISTRATOR Vl(pFla,(CI�fI : <br /> En vi <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> O� �THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />