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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 /> 7 n O <br /> m <br /> OWNER ?-J TELEPHONE -��-G 71 w K <br /> MAILING ADDRESS �7 f"!5 7 �lN� L/ �/�/ G ? <br /> //�� Lcc�C QJ r <br /> PROPERTY ADDRESS B 6JSv(� "6,L <br /> LEGAL DESCRIPTION(see tax receipt) t CS �V )r1 Pa 5 3 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION W <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ C,A)MPING UNIT ❑ SS. <br /> ��jUBD))IVaISIONN�❑ � �(+0 <br /> STRUCTURE/ADDITION USE: `I X It b' /TZAt��C�� �� 4 'f'�i��/J� Z c� ) <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) xrejv1 <br /> L m <br /> BUILDING CONTRACTOR: o <br /> n <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 (� b z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. n` <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO i� Q O <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. CZm <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. M ` c <br /> CONDITIONS OF PERMIT: pp 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE%RtvET' 1 <br /> ISSUANCE. ZQ CQUN 3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NIIIG ` r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY _410 O <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. �y C C <br /> m 0=0,19 R * <br /> 6. m 3 am Pr= M <br /> o C y In O j <br /> 7. Z m m 0 ro <br /> o :j!'< _'; m <br /> 1 declare that this application(including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of w n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- ? G� <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 m ? E <br /> providing in this application. I agree to permit coup officials charged with administering county ordinances or other <br /> P 9 PP 9 Pe county 9e 9 tY E m E <br /> m : mi <br /> authorized person to have access t scribed premises at any reasonable time for the purpose of inspection. - o, <br /> SIGN HERE <br /> (signature of owner or buftng c t actor) (date) <br /> � <br /> ` <br /> ZONING1 ADMINISTRATOR <br /> N <br /> $ <br /> J,.,ry�_yJ✓ O N O f71 ro <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> r ��/U THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />