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Burnett County 7410 Co. Rd. K,No.102, Siren,WI 54872 Office of Zoning Administrator _0 0 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> y O <br /> CD <br /> OWNER I/iL L TELEPHONE <br /> /b�J9G� %9��fE 7� �f �-y� y w <br /> MAILINGADDRESS 2 93�/ /04'rXC 1 /F y �j��,(��' �� o O <br /> r � <br /> PROPERTY ADDRESS f /a _ [ ) µ� O G <br /> LEGAL DESCRIPTION(see tax receipt) 740U 1}�m <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 2r ADDITION ❑ <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑q CAMPING UNIT ❑ SUBDIVISION F1TRUCTUR ADDITION USE: Fym7 �y� o G <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) cn _ <br /> /7 m <br /> BUILDING CONTRACTOR: �A C171� <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 r` <br /> M y V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 CD -� <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mjp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N Is 3 <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. 9 <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 06 <br /> MUST BE SIGNED AND DATED BY THE OWNER. £ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (f� <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 AREA. <br /> 5. <br /> CD ww0CDCL m <br /> a m C N w o 7+ <br /> 7. Z w m o m <br /> o Tom : i On <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m E r^' O <br /> PP ( 9 Y ) Y Y 02 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m a-`2 • 'A <br /> : : A <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize q m m v'c A <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. I furtccept all liability which may be a result of the Coun Q�Q�� r ation I am m <br /> providing in this, ppi' ation. I a e to permit county officials chargedyw Q[fti stet c@(rrfE��¢r n or other E E <br /> ddmH tie du( <br /> authorized person ha ace o the above described remises at an I n ection. o , <br /> cD m i <br /> SIGN HERE JUL`` d' C : <br /> (s na ure of r or building contractor) V dat ) ° a <br /> ZONING ADMINISTRATO �' <br /> ZONING � (A `"0 N <br /> � o (Aoo <br /> I e TOWNSHIP PERMITS MAY BE REQUIRED <br /> �( 1�a ( IIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />