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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 o 0 <br /> 3. `» <br /> APPLICATION FOR LAND USE PERMITS p� <br /> y ° S <br /> CD <br /> N <br /> C <br /> OWNER fS'Q.�-�/ 4a h/ t ki-6 /Qc r C$elf I TELEPHONE /1 S- <br /> {/ 7 O <br /> MAILING ADDRESS 12.5 IJ M4.A✓cy V 4.�h Ur e Vi <br /> � O o <br /> PROPERTYADDRESS # -3s 30 4p«L <br /> 6 \ <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) ID <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ` 0 <br /> TYPE OF PERMIT(S): q <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> ❑ �DISIO�N /I rn�m N( <br /> . <br /> , N <br /> i* ^u <br /> STRUCTURE/ADDITION USE Home/;a <br /> bin; Commercial Business; room;Deck; etc.) 02 <br /> BUILDING CONTRACTOR: 6ohS t o <br /> � <br /> � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3. , <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Cee �F}N 1/y{n� '�17Yr�r / �c�S 0 n <br /> S S U I � ' to / l kXayG3 0 CCD <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 1 r' Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO S( LE. �SS �-S �l n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 9 _ <br /> NORTH(N). m 1/'3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO ) + <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Zo <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 p Y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN N <br /> o �\ <br /> NEEDED. I <br /> Z S <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: n 1 Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT QY✓� 1` I� 1 <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. CID <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. Y �+ � <br /> (JfhXV� m cwr- > f m <br /> � 3 nm % RSM <br /> 6. o� cmyOj3 <br /> Z c y o : 1 <br /> P m T < : m <br /> 7. = rnE <br /> : O <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my 49 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> CD that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o m0 <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 V": <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other : m j <br /> authorized person to have access to the above described premises any reasonable time for the purpose of inspection. T n <br /> m <br /> CDD ; <br /> �( �f['LyLr' • 1p Z 6 a <br /> SIGN HERE o <br /> C.c ti5 e <br /> (signature of owner or building contractor) <br /> (date) <br /> ZONING ADMINISTRATOR <br /> C O N (T W W N O <br /> C ONO (.T (T fT O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />