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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> to O SO <br /> C <br /> c <br /> /t `�C� nl <br /> OWNER ��.f- ' TELEPHONE 9 5-2— /J /�/q�/J S / / 7 � .\' <br /> C I- n / 7 <br /> MAILINGADDRESS I aS Q CD OY <br /> el /teyt(,tr-St �/, Bu ( /�$ iJ/ ' �/ V ��✓i� <br /> r <br /> q 1 C f' ' o <br /> PROPERTYADDRESS a) 7 I I q CT y �� w ehslel- w� J J1 F93 <br /> Parcel 0 07-0 3G,~ J�- 16=17--AG-L) —"'A C �� �„1 P� 1-�c 1 02 CS M V 7 � <br /> M I 15 P -57 Y / <br /> LEGAL DESCRIPTION(see tax receipt) l—�� CS! I v I d75 1 ngUy /O T r w <br /> m <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION Elm 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ O l �. , <br /> STRUCTURE/ADDITION USE: <br /> r a <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;/g�JC.) m <br /> BUILDING CONTRACTOR: h�f e- - 4o u r!5 ( 0 ASf/r U04100\. l/li/I Pfof, <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> -n 3. <br /> OM <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T O (/! Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <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. P <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. V <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Iv Uj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANSt 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. a ^� <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 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 00 ( ) <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. kuXi'v-d ID <br /> /l I � /� M p C� rDVDl7 � <br /> 6. �W1 �l /� 01 � 00iCOOinf m <br /> llel—f <br /> 7. -! /\ VVV u! O O . t. <br /> S O T m <br /> I declare that this application (including any accompanying schedule) h s been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m0 : <n <br /> L— : n : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 91 m C : o v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 oO <br /> providing in this application. I agree to permit cunty officials charged with administering county ordinances or other o <br /> authorized person to have access to the ab scribed premises a any reasonable time for the purpose of inspection. ° o <br /> y�3 /dz <br /> SIGN HERE <br /> : a <br /> (signatwfe er or buildinsf contractor) 1� (date) <br /> Lf� <br /> ZONING ADMINISTRATOR � � te <br /> E»O N <br /> N <br /> EA NI r)6NN <br /> 0(TNOO <br /> Q �NO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />