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1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r 1, <br /> N rn lV <br /> —� <br /> OWNER I ct m P_ S 7- �_ 4 r , :-moi S(,1—� TELEPHONE �I'7 <br /> MAILINGADDRESS 0� <br /> r � <br /> , 1 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) S yy lieco <br /> m <br /> DWELLING/BUILDING � GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <'Cn o <br /> TYPE OF PERMIT(S): C <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> <. (1 <br /> STRUCTURE/ADDITION USE: p7 o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> S v� 1�ss�es�n M�,v- �A-A�5 <br /> BUILDING CONTRACTOR: / . <br /> v <br /> -4 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �Li(tA� - tif}a 11-'jOT 3 G C/) <br /> V O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> nn <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cn <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. o <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. O <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 /> O <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O T <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: rU 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. t <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 W ER <br /> SETBACK AREA. 7� y a ad xA�(� <br /> 5. Fk(�h5 e"10, iz b� Cbwuer T� ��U o <br /> C W D O D O M <br /> /Ua { Mary l-�ud� fr>•�, �s e t!�� a 0 3 a � a <br /> 7I o <br /> Z c o -� <br /> o m it's m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m - (' A <br /> PP ( 9 Y ) 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 2 : i C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m cn <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 w o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,p p <br /> authorized personjito have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> D . <br /> SIGN HERE <br /> (sig a of ownerpr bijilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> O <br /> wo6o6 �en en sano <br /> THIS <br /> vWic <br /> TOWNSHIP PERMITS MAY BE REQUIRED � <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />