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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> N � <br /> N <br /> OWNER �!QS- / � TELEPHONE n \1N1 <br /> v <br /> m <br /> MAILINGADDRESS 2(:3g 54+M(2r� yyt� O <br /> PROPERTY ADDRESS ��6a 0L /?_ <br /> LEGAL DESCRIPTION(see tax receipt) �' ems`/{ y �. /V aa�9 14A9 � <br /> DWELLING/BUILDING LlGARAGE/ACCESSORY STRUCTURE El ADDITION ❑ <br /> TYPE OF PERMIT(S): rn O� <br /> c <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> 77 ..Lt 3N <br /> 1 / <_ _ <br /> STRUCTURE/ADDITION USE: <br /> Rt/Q ca* 3Nos /o l q to (G✓� s joS jA-'posts y_ <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) ' <br /> BUILDING CONTRACTOR: IA at�rl.c, <br /> —,.�— /%/t t rt eOnSt/kdl d <br /> m <br /> Z � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> O - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0[C A <br /> O m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rm <br /> o A O <br /> m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CA <br /> M 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o ,9J <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <br /> P <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO SL) <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS NC7 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' I <br /> o �( <br /> NOTE: NGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. o <br /> NEEDED. 'ry <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 'VInI <br /> CONDITIONS OF PERMIT: o "{ <br /> (p] <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. pp <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER K! <br /> SETBACK AREA. <br /> 5. <br /> 6. m cm oor n 0o > <br /> m x3 n0 xamA <br /> 7. a p m C N <br /> Z 2 N A O 10 1 <br /> N . <br /> O A T� : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — �' i»; p <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and accu <br /> racy of m `: ( S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ? m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is M <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m': 0 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> m' W <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE > : <br /> d v a <br /> (sl ature o owner i building contractor) (date) 0 : <br /> ZONING ADMINISTRATOR <br /> �69(fl f9 fA�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N W O N O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />