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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> 111 APPLICATION FOR LAND USE PERMITS . <br /> r <br /> 7 M ! o <br /> OWNER /4rjC4lL ftr%^-t- 131Zw�LA TELEPHONE (76 <br /> MAILING ADDRESS v �q(( /1$ 61gni-a- P'y n^61A An/V � O <br /> f <br /> CD <br /> i'Tjt� o <br /> PROPERTYADDRESS <br /> I �l'S1 �(�nroyi/1 RcI <br /> , sry i Q-) � � <br /> LEGAL DESCRIPTION(see tax receipt) `cn <br /> O <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE F1ADDITION El (n rn o <br /> o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> < \ <br /> STRUCTURE/ADDITION USE: / E/C.o4-OL/0 ? <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) S <br /> BUILDING CONTRACTOR: CCP n.t1 I X^ C- . <br /> m <br /> -r Non vn� ,Z) <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR � C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> :0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C �'- O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO Cl) G �3 <br /> CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ) 0 <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS Q 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST 8E STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN v'» 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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 AR�A <br /> 5. Er 05,ori C!ur*✓f'o 11016 n b q UDC. rs mad-(. 0, �Dnd-�h on D-F 4-h%s /Oe+''m rf- <br /> �7 IAOr DD � <br /> (D c m M n m a f rrl <br /> 6. m x 3 n m x a A <br /> p N C y N 0 3 <br /> 7. Z c m 0 i 1 <br /> P CD _ 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 U)C N C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ryry`` m �_ <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize W m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is vi : O <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinance <br /> authorized person <br /> _��ve access to the above described premises at any reasonable t VR@qr o m <br /> n : <br /> Di <br /> SIGN HERE <br /> (signature of owner or building contractor) f�t� (date) o <br /> ZONING ADMINISTRATOR APR 2 R � J <br /> in in in <br /> EA EA N <br /> ocnOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY O N NWWNO <br /> MNG <br /> v <br /> THIS PERMIT S�HALLL EXPI E ONE YEAR FROM DATE OF ISSUAN <br /> I to I l-f�t�� )eft --D Suri Sem ✓s4l u.G�6n `7 <br />