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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> y O <br /> 0 <br /> OWNER ZA ME 5 /'L�/✓ TELEPHONE 17 /� — O�� � �17 1q15" v � <br /> m O <br /> MAILINGADDRESS77 ,/� R f <br /> 2n? !/ ��.CJi 1J r l �N�u�4 , Wer 5-YE,? 7 <br /> r (D <br /> 0 <br /> PROPERTY ADDRESS Cv. R U L)4-V Nilw <br /> LEGAL DESCRIPTION(see tax receipt) LI A 09 I � V/ a(� 0-r— V-eIIOUJ �, m <br /> n <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITIjalON ❑ (G>. <br /> TYPE OFPERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 1 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 1�) ( Lem 2. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 qZ (e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A w j0 1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. T � <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 0 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI DONE WHEN o <br /> NEEDED. /[>7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 I <br /> CONDITIONS OF PERMIT: pp ` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS CPi3fl T? V , <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR <br /> 3. NO GRADING DING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY /PER 'Y� Y� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5' I This structure to be used as private residential <br /> 6. garage/storage only. Not to be used for human ,�, w�m n m <br /> 0 3 a m x a u <br /> habitation. <br /> 7. n m 0 <br /> ;_, m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — D <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm 0 : v : <br /> i <br /> G C 0 • m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o G <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 w E <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized p rson to have access to the above described premises at any reasonable time for the purpose of inspection. m c <br /> CD <br /> SIGN HERE e7 <br /> (signature o or building contrawry (date) <br /> ZONING ANIMINISTRATOR <br /> 69 vi En <br /> fA 06)fA0N <br /> � � �` N �TNN 00 <br /> Q <br /> 1 V � TOWNSHIP PERMITS MAY BE REQUIRED (S N o Ln cn o 0 <br /> " p�I THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />