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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS �. <br /> r <br /> m v <br /> OWNER �Z)l V DSM K LI TELEPHONE(6r---775--O 1 75- <br /> MAILING ADDRESS R F1-ANb1ZAr44 S%. /11 PL EWcon ^V S5'10m <br /> /lleXE t� <br /> {J1 Y r <br /> PROPERTY ADDRESS 1)(� 1w`J <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) CO(),,LsT 5-, L,OT <br /> aZ& ,�, T yQ a-9 /y <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ ` W 0 <br /> TYPE OFPERMIT(S): I /JI cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S D� `-" � � <br /> N <br /> STRUCTURE/ADDITION USE: �+ ° <br /> ( om /( In;Commercial Business; Bedroom; Deck;etc.) in <br /> BUILDING CONTRACTOR: 00e4tre. STGNj1 �ws� z <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X f 1 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p c <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m .v <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 <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. I <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » 1 <br /> y <br /> NEEDED. » <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: <br /> 1 '�S' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT pp �' <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. (n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. �r , <br /> 5. ' 'Q <br /> 1L 71 m m; 0anf m <br /> 6. 03 <br /> 'o m Cm <br /> 7. <br /> Z <br /> O it'sCD i m <br /> 1 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 i L7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of iu <br /> am : -ton <br /> „ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m r : 0 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 ro <br /> providing in this application. I agree to permit county officials ch ty ordinances or other o <br /> authorized person to have access to the above described premise •sa Y r ose of Inspection. m m ; o:: <br /> CD m ` <br /> SIGN HERE <br /> (signatur<511yowner or build gontractij(date) ` a <br /> j JUL 7 M L <br /> ZONING ADMINISTRATOR ( � i <br /> � 1 � BURNETT COUNTY N(Mro ro <br /> op <br /> cno0u 00 <br /> G0TOWNSHIP PERMITS MAY BE REG NG <br /> 13,6 LtHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />