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Burnett County 7410 Co. Rd. K, No. 102,Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS �. < <br /> N If <br /> OWNER (,rJ SP7'h TELEPHONE 763_ 7S7— o <br /> o lJJ <br /> MAILINGADDRESSAp, dG3 <br /> 11Z �3 Rfl�a: t�$O� Qh GrooN AfP,,IS rnI✓, �S'yO <br /> _ Q o <br /> PROPERTY ADDRESS �A P,( <br /> I "�10 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> L1 4,3 T�"I.ry Lln(S I�� I n� f! C <br /> DWELLING/BUILDING 1:1GIARAGE/ACCESSORY STRUCTURE K ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °: <br /> STRUCTURE/ADDITION USE: LrAJ/ f or+r7;.rt e ; tj Fu?,j► C o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> d <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y�X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m o <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. o <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 CU <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o .Q <br /> NEEDED. <br /> n C� <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 PERMIT W <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. <br /> 6. m c03mm0Ma : m <br /> m � 3 am yam A <br /> 0 N C y N O 3 <br /> 7. Z C N N O (O <br /> o m Tom . . . m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m �j A <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o n c4 C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize CD i m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d 1—D <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 in <br /> d o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ° m <br /> � . <br /> authorized person to have access to the above described premises at any reasor(a do . <br /> CD <br /> cif : a <br /> SIGN HERE D D <br /> v> a <br /> '(signatureof owner or building contractor) (date) j <br /> ZONING ADMINISTRATORVM OCT 1 ? M (� <br /> LJ U <br /> v in in in <br /> >fA EA Efl Efl> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED Bt1RNETT COUNTY <br /> O OUlO (W11N (N110 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU NG (ylIle 84 p <br />