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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> rn O <br /> c <br /> n D© <br /> OWNER �i y�A = TELEPHONE 6 y,_ IJ�? <br /> O <br /> MAILING ADDRESS z S`' <br /> (A)7r- (D \� <br /> 0 <br /> PROPERTY ADDRESS S p vete <br /> LEGAL DESCRIPTION(see tax receipt) PC) C,4 'U '��l 'T C� s) 1 v I c <br /> � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE w 1 i <br /> I��f( ADDITION ❑ o <br /> J <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ AMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE ADDITION USE: ��C I t�n �� \ <br /> (Home/Cabin, Com ercial usiness; Bedroom; Deck; etc.) >b <br /> BUILDING CONTRACTOR: V'd-V\ 0 y C d`aC1J iv <br /> Q8x Vd <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF APER. WNY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 77 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o 0 <br /> m <br /> 71 o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C NORTH O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINP(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF L 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 VJ <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. 0 0 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI E q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. MAV j I o i <br /> CONDITIONS OF PERMIT: ICORL 6 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERIVIW'fNf!T r 'DV � I <br /> 190 <br /> 2. REMOVISSUANCAL CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ZOIV1 N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C}I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER \ <br /> SETBACK AREA. <br /> 5. UT-n d rfi?m- OvlCti,yj�yVf t Yn �l e�►�cti►tet s, -- o �1578-11 C/ <br /> 6. PV'Ish t' av' liwo�{� C/vyt'{�� �, / � 3 am O�nm M <br /> /�"�/ vL C y N O J <br /> 7. h�w �t i'tc�Q' /�c� �t( e t7 ct� P �: w m o J a <br /> ° m <br /> declare that this application (including an accompanyingschedule has been examined b me and to he best of m _ O <br /> PP ( 9 Y ) Y Y G)- , C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail a d accuracy of m 0 <br /> g P 9 P a» 70 <br /> all information contained in this application(including any accompanying schedule)and I further declare hat I recognize I : $ . m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `C ; � G <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 E <br /> providing in this application. I gree to p mit cou ty officials charged with administering county ordinances or other ° <br /> authorized person to have acc s to the a ve des ibed premises at any reasonable time for the purpose of Inspection. ,t m o <br /> CD s� L m m : <br /> SIGN HERE �/ Is �" '• d <br /> J : <br /> (signature o owner or building co tractor) (date � C' <br /> ZONING ADMINISTRATOR <br /> C4ea <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> O <br /> 0-1112 r THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> , <br />