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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> f� �T 0 <br /> .D <br /> OWNER �.�A'� t ,�ivJr7KfY ��' TELEPHONE <br /> N <br /> �+. <br /> ��q /� <br /> /- <br /> MAILINGADDRESS �� � / '� 144k 4Z � Ajt/hflsS1 /V /y/V S,4317 <br /> PROPERTYADDRESS ,1764- AAISOnI le-F A0, �/Qi9/dTS f3C-2g W�SLr _ J <br /> LEGAL DESCRIPTION(see tax receipt) o 19 �,�d�NS �0�� 3� _ r3�/U 2�W Q <br /> / (- <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 0 <br /> TYPE OF PERMIT(S): cC <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: 6%1131A/ F �jt0l- <br /> g M) Pd <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) � <br /> m <br /> BUILDING CONTRACTOR: UC3 I✓9771.�«ST <br /> v <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 O G� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C) _ 0 <br /> m V, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <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 ° r <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 <br /> � o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 , <br /> 70 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `p <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> o <br /> m0r- > onov <br /> 6. o > W 0 CD f m <br /> m F3 am Oc ': ax <br /> a =r CD <br /> 7. Z c y m o 0 0 1 <br /> P m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of—my q A <br /> PP (� 9 Y ) Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m c ' m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 v> : <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 /> L7 : = : <br /> d o : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other �' m' <br /> CD <br /> authorized person t access to th ove described premises at any reasonable time for the purpose ose of ins ecti m a <br /> m D <br /> SIGN HERE D m a <br /> I re of ow o building contractor) (date) - <br /> � : <br /> ZONING ADMINISTRATOR � <br /> fA i�iA <br /> '' (} EA'A EA 6% N <br /> a o cNn o cW c�''irQo <br /> TOWNSHIP PERMITS MAY BE REQUIRED URNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF I SUANg6NI G <br />