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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 . ` &D <br /> r <br /> y O <br /> c <br /> OWNER ) a.r ry FaAn ct M� a n �>Z�e p k� TELEPHONE Z/5- 3 <br /> /" k <br /> y�p I k e / /� O <br /> MAILING ADDRESS 98� )d6rt4. IM LL� Y1- q /(- Oe4.51(on �7 <br /> o <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) LQ ( a 0Sn-� $ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE XL ADDITION ❑ c <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: P-O�I P`N60 , l� <br /> c II (Home/Cabin;; omryJm��ercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �h KVLZ;q V< /� �t 2 r C<, <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m w D <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)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)TO m3 <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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. nl ) <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: <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. <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 /> (Dpnim0 CD CL :E rn <br /> rn <br /> NSam0 0xnOm <br /> X1 <br /> 0 C y y O JM <br /> Zm t3 <br /> 7. <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m �- : O <br /> PP ( 9 Y ) y y O c ; i ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n : u,: <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o In <br /> that this information I am providing will be relied upon by the County of Burnett o n in determining whether to is- ; 0 ; <br /> sue a permit. I further accept all liability which may be a result of the County q I on I am <br /> providing in this application. I agree to permit county officials charged wit ftmth( Yo r other E SDm <br /> authorized person to have access to the above described premises at any reas sable;tle u i ction. m o <br /> A ✓ m i 'm <br /> SIGN HEREAP - d' <br /> (signature of w building contractor) I�. ' n <br /> r '• <br /> w <br /> i m 13URNETT col ISITy � <br /> ZONING ADMINISTRATOR IGf 1 <br /> l�a;/eon >C9/1 N 7 rel( J N N N O O <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED c o cn o 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE h <br />