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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, UJ <br /> N <br /> C <br /> ��11 �A <br /> OWNER �/- AA(�/✓TZ m el o ql a.kzr M2 C//t�i1RA- TELEPHONE7L3 <br /> �/ /� i ' ;D m <br /> MAILINGADDRESS � 73 49 (.� �a YLrkM S �"'/V l,J l`2,kAVC--� /1A/ 871)3FO <br /> PROPERTY ADDRESS f'/,'r If y� O V G r N tA• 4J I� �-- (j�oL�) <br /> oo t \ <br /> LEGAL DESCRIPTION(see tax receipt) �O '�'" j� I Q V Gh I2v�N /} N <br /> m <br /> IIS�II <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE lel ADDITION ❑ rn O <br /> c � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ T. <br /> N_ <br /> STRUCTURE/ADDITION USE: G Z N2 G o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> Q (� 2_ <br /> BUILDING CONTRACTOR: <br /> 0 O <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 'n 4 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M N � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n <br /> n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. - C1 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C :° n <br /> NORTH(N). Ca 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(8)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. t ' 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C, ` <br /> BUILDINGS, ROADS, LAKE,LOT LINES. 7V \ <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. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o / n <br /> NEEDED. c' V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �I d <br /> CONDITIONS OF PERMIT: 1� <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. J d O <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 /> 5. <br /> m ca W m 0 ° a ° m <br /> 0 F3 nm xa '= U <br /> 6. 'o 00cN '.' o � 3 <br /> ZC N N O 710 'i <br /> 7. P m 2i : m <br /> = m : a D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ; 0 <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso to have access to the above described premises at any reasonable time for the purpose of Inspection. m o. <br /> D ; <br /> O ° <br /> SIGN HERE 0� n <br /> (signature of own or building contractor) (date) <br /> ZONING ADMINISTRATOR sl� <br /> 69 Hi <br /> 0 W N <br /> rN <br /> 001VWi fTO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> 7erm.i-t ✓ -4 amara �1-�°I�{� <br />