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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator I -U o° o <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 <br /> N <br /> N <br /> OWNER �otV Al_(JR S ft <br /> 4 N TELEPHONE CL51 �7��— O CJ d �LVV ^wp :c <br /> MAILING ADDRESS <br /> 6o-- N �Rt6 lv Y�1�li �Sll� <br /> I(7R�i�JjL�d / r m <br /> PROPERTY ADDRESS 6P a -96 _Aa L�(" �CIS h U I3 <br /> t(�v?U J , L�-v�2J� J p , CD 70 <br /> LEGAL DESCRIPTION(see tax receipt) N CD <br /> Cn <br /> / a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB IVVIIISION ❑ <; <br /> STRUCTURE/ADDITION USE: <br /> � <br /> (Ho e/Cabin; CoU <br /> �- Llmmercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ci <br /> --I V <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h 4.X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> y � <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) O a <br /> T p <br /> TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mo <br /> NORTH(N). <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 <br /> Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 11 <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. <br /> 0 <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN P. a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o S� <br /> CONDITIONS OF PERMIT: � <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> ' eY M oravavv <br /> 93o— V cul 0-n 07` m m w o 9 a F m <br /> m 3Cam � = 33 <br /> 6. mCM `.�' c � � <br /> Z <br /> W o i ' o <br /> 7. P i =n'< '. m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the beO <br /> at of my {j, <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o : fA C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m CD <br /> C c 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. 1 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 n <br /> m E m i <br /> authorized p ave access tot described premises at any reasonable time for the purpose of Inspection. o <br /> mOD <br /> i <br /> SIGN HERE �� <br /> (signature of owner or buildi7CL <br /> ctor) (date)) <br /> ZONING ADMINISTRATOR tu <br /> fA fA fA 69 N <br /> q V OCA CNn OO <br /> J� TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />