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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 . <br /> r <br /> N O <br /> /yA,Un' C V <br /> CD <br /> f <br /> OWNER t yy ��' TELEPHONE go� 3�� <br /> m OMAILINGADDRESS33l/ C kwop-m-, F <br /> r � <br /> PROPERTY ADDRESSOtis-, cjx7 ) o <br /> ( P) acv �� I -� -� C <br /> LEGAL DESCRIPTION see Tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ y o <br /> TYPE OFPERMIT(S): Cr <br /> ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °0 <br /> a / �y, <br /> STRUCTURE/ADDITIONOSE: y <br /> O <br /> (Home/Cabins; C�om�me�r1c6l Business; Bedroom; Deck; etc.) y <br /> BUILDING CONTRACTOR: ! IV P-L VA-L' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. I <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> m z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C> <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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 /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 91 <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 AREA. <br /> 5. <br /> CD 0 I=, CO) i cat <br /> 6. m amx ;wD <br /> a m C y <br /> 7. Z N 0 O O <br /> ° <br /> "n <br /> =(n i i 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 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � <br /> 1 m 2 : v,: <br /> Cl L' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mCDy <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 rel n this information I am m <br /> providing in this application. I agree to permit county officials char a n I ty ordinances or other f <br /> authorized person to have access to the above described premise y e u pose of spection. m o <br /> 0I m i m <br /> SIGN HERE 1 �( <br /> (signature o1 owner or building contr r) 2 2QfA (date) <br /> ZONING ADMINISTRATOR I E E <br /> (� / Rl lR TT COU o?d�� r'/1 6,6,1r�,- ro <br /> 1 Ia 1 lP- � & P <br /> Ver <br /> Var I TOW SHIP ERMITS MAY WE � Q N o L" Ln 0 0 <br /> q---o THIS PERMIT SHALL EXPIRE ONE YEAR FROM ATE OF ISSUANCE <br />