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Burnett County 7410 Co. Rd. K,No.102,Siren,W154872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS �. < <br /> r N <br /> c <br /> O <br /> CL w <br /> OWNER S O TELEPHONE <br /> m <br /> MAILING ADDRESS v (�� 1 1(_t JQ U U I /v SII O <br /> Qm <br /> PROPERTY ADDRESS �)Z j 14 1�� <br /> 3 <br /> LEGAL DESCRIPTION(see tax receipt) CS m v I S psiG-1_ 5 Jq7 V 0 -� CD <br /> u' <br /> Of a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ Q 0= <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �"'� - ,v H <br /> STRUCTURE/ADDITION USE: k3tj `Y <br /> (Home/Cabin; Commercial Business; Bedroom; Decl; etc.) (—r[ <br /> BUILDING CONTRACTOR: t tJ + Q4 w <br /> n <br /> _ (O <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR _3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 301 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n a <br /> M v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> NORTH <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. Q , <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �v M <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 5 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> v o -(Z- <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITLb <br /> �/1 <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 W <br /> PERMITTED. W O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. IS f <br /> 5. � -7- � -D�/ . C. � hc ��sta0(atrv- <br /> m nOwrDima010m <br /> 6. 3o a , �, am >1 <br /> m <br /> v m Cy <br /> Z n m o <br /> 7. ° ^ ` 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 e7 c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of C v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ^^+ E m m o m <br /> e <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Cil <br /> sue a permit. I further accept all liability which may be a re on this information I am m <br /> providing in this applic on. I agr a to permit county offi ' 1 gMiatM* <br /> my ordinances or other E o c <br /> authorized p on to h e cc t e above described purpose of inspection. n m c <br /> io m <br /> SIGN HERE _ r" <br /> nature of owner r ilding con actor) JUL 7 (date) o_ <br /> ZONING ADMINISTRATOR UI E i <br /> 77OpryryII ((); <br /> �t1�k TOWNSHIP PERMITS MAY BE REQIf1AED <br /> 'f U J�T ' HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />