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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator -U 0 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> y O <br /> fA <br /> C <br /> / /� • ., 1 / c n / a <br /> OWNER <br /> �-�1 � 2�0�-DrA TELEPHONE <br /> m <br /> MAILING ADDRESS ? `I Lt^ du wc�' �c JI i ��c1S P(�. til/v l�j <br /> r m <br /> n <br /> PROPERTYADDRESS X623 17'Y�RiL 1��2AN �� �� 0 <br /> LEGAL DESCRIPTION(see tax receipt) Csm V d • q3 <br /> DWELLINGBUILDING Pr GARAGE/ACCESSORY STRUCTURE ❑ ADDITION O <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING ❑ CAMMPINGUNIT ElSUBDIVISION El ..A °` <br /> STRUCTURE/ADDITION USE: I�ERAr�A .G-DLD,Z� � <br /> 1tQG�`S-q�� �v -CA?-9 k o N <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: /Vw -� ZjNH m <br /> CD <br /> C C <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> ?t o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m j� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ( <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Ul 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 d <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 PLANS0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. �. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o d <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r, <br /> ISSUANCE. t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (j <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �l <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK/AfRElA1.y// �t /[� <br /> HA,c./�. �� �i �i/��k..G� �!g/""� SAO /S�a`1r ��G. Qty. `/ 17 (�r D 0 D O V <br /> M y 01 0 m G £ m <br /> 6. mRa�oxz ° � <br /> O � N <br /> I Z y m O : <br /> P -n< : <br /> = m : m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of f» <br /> 201 v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm o mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G) <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 ap li "' n. I r o permit county officials charged with administering county ordinances or other o <br /> authorized have a c ss th above described premises at any reasonable time for the purposeof inspection. m m o <br /> SIGN HERE D � v ,k . . <br /> -Z-2-9 -01 m m <br /> 0 <br /> Ire mone building contractor) (date) I� � nZONING ADMINISTR TOR �c � lJ <br /> EA EA EA EA � N <br /> HUU'_l d P/,� po n', N O1 N N O O <br /> CVV (�, TOWNSHIP PERMITS MAY BE REQUIRED (n 0 0 0 0 0 <br /> 0=6rq� "ERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />