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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> �Qn < TELEPHONE ( ( t. 3333 <br /> t� <br /> j 0� <br /> OWNER <br /> MAILING ADDRESS D 1 BC)(rY-1CLI) Lx `r'`'I �i1yyt- Cxovo - Q,I4� ts, ryi&) �-7� <br /> r m <br /> O <br /> PROPERTY ADDRESS Xncp mOhlor1 DSI✓e 1Dar)bor+ IJ7 r�uf�3,p ~ <br /> „ � A <br /> LEGAL DESCRIPTION(see tax receipt) L0} I moll -A--t-esTry l4 I ti 1(p W , S(,)tSS TOtdrr4I� CCD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X 7,5 rn <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. (C� <br /> 0 I <br /> STRUCTURE/ADDITIONUSE: C i✓) (lrYlP 0 <br /> _ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: yADWS n_ (-( '7"tnyj <br /> -o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN&/i X 11 SHEET OF PAPER. ANY INCOMPLETE ORT 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p m <br /> �t N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> ?f v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m :13r] <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> Co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> 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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C3 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. W <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. J f <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN IS q <br /> NEEDED. (`J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � 2WE o 1 <br /> CONDITIONS OF PERMIT: I <br /> u. <br /> y � 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS' PERK 2 8 � <br /> ISSUANCE. �1 G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG Sji . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY zp f�C.((O��UNT Y <br /> 4. NO STPERMI UCTTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED 'ATEA COUNTY <br /> G <br /> SETBACK AREA. e <br /> 5. S i fit- '�a-`� —0-k �a css u2� <br /> M mmcDi ID CL m <br /> 6. m 3 am xa `c <br /> m C y y O j <br /> Z W 0 O i O 0 <br /> 7. <br /> o J m <br /> � <br /> 1 declare that this application(including any accompanying schedule) has been examined by me and to the best of my �2 <br /> � c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> �: O. C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m S M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 17 <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 application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. : m o <br /> m m <br /> SIGN HERE <br /> (signs f owner or bui 1 g contractor) (date) <br /> ZONING ADMINISTRATOR < akq 16AZt-/ <br /> f TOWNSHIP PERMITS MAY BE REQUIRED <br /> r ��U THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE V1(P)U1 <br />