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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS . p� <br /> N <br /> OWNER f L- /F �C' i�/} it •/ ) TELEF410NE 7/ i'"' y LO 1414 0 e ^9 <br /> w o0 <br /> MAILING ADDRESS ��- l r H ��1�dh y �. ,f r( O <br /> PROPERTY ADDRESS S`f M F_ bo <br /> LEGAL DESCRIPTION(see tax receipt) LO f 1 CSM ✓ 7P -LOG Cf,v 6 '�- I, �y C u v 1-0, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ cn <br /> TYPE OF PERMIT(S): c <br /> FILUNG/G� 11ElRADING CAMPING UNIT SUBDIVISION <br /> ) ❑ o-° <br /> STRUCTURE/ADDITION USE: �o�(�I L Ft Y11A d /,2 o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) rn <br /> w <br /> BUILDING CONTRACTOR: !f't Y <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR (D <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p 3 <br /> 31 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> ?� 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d <br /> BUILDINGS,ROADS, LAKE, LOT LINES. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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 o / <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI7�� 4 1 A WHEN o w <br /> NEEDED. �V / <br /> �LJ 4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ) <br /> CONDITIONS OF PERMIT: -f 4tlG UJ <br /> 1 <br /> ISSUANCE. <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF��y., <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINCO P CO N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY NJNG U <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential M o0, j>o a o m <br /> 6. garage/storage only. Not to be used for human CD 3 a m n,�, M <br /> v 0 C y <br /> 7. habitation. o N m <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m • 3 m • 0 <br /> PP ( 9 Y ) Y Y E L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of : c, o , fn <br /> ra <br /> cn . <br /> a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E o m <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other t o <br /> authorized person to have access to the above described premises at any reasonable time for the m <br /> thhe purpose of Inspection. <br /> m o <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) c <br /> ZONING ADMINISTRATORy 1 Y11 r lan��/1 UI E E E <br /> �Q5g3 W(a(a W N <br /> -6y TOWNSHIP PERMITSAY BE REQUIRED �oro " oo <br /> L THIS PERMIT SHALL EXPIRE ONE YA YEAR FROM DATE OF ISSUANCE <br />