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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS �. <br /> r <br /> y <br /> c r� <br /> OWNER .._ � ��/ ( .'( TELEPHONE715- row'3LMo <br /> MAILINGADDRESSV <br /> cam_ �{y �i 1.�� �-�,�D �✓N rrc� �2_ 1�1>\] si!5 11 r> <br /> r � <br /> 1 g (' � <br /> PROPERTY ADDRESS L�� -INP�dey� 1 — CZ VJ <br /> LEGAL DESCRIPTION(see tax receipt) C <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE �, ADDITION (n <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADINGElCAMPING UNIT ❑ SUBDIVISION El �\ <br /> STRUCTURE/ADDITION USE: G�aQAr tip A m` (z), X oZ 0( � (O <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) D. <br /> cn <br /> N <br /> BUILDING CONTRACTOR: <br /> 1 LC�r�S 5 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n 9 <br /> n J <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m Oq �Q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). (n^ ` 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. 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. N Y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS Q 0 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o �n1 <br /> NEEDED. <br /> Y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Y pb <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 on D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER \ <br /> SETBACK AREA. �+ <br /> 5. <br /> X W n r D O DO -0 <br /> ° a * m <br /> 6. m x3 nm x = ;a <br /> 0m c �' o 3 <br /> 7. Z c m m o <br /> =_ cn m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m (n : A <br /> PP ( 9 Y ) Y Y G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of _ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c : mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am m o <br /> providing in this application. I agree to permit county officials charged with d t ==r=e r other j <br /> authorized person to have a ess to the above described premises at any rea s tion. r a <br /> LD Di <br /> CL : <br /> SIGN HERE 1-7 b " a <br /> of owner r b "Iding contractor) 7 (date) 0 <br /> JUN 1 r 2005ry <br /> ZONING ADMINISTRATOR e 1 <br /> -�f <br /> ffl Vi EA EA� N <br /> BURNETT COUNTY N W N o <br /> TOWNSHIP PERMITS MAY BE REQUIRED QQ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE O IS, bs- <br /> �e�rn��- �� 9VM-jSCn (- - <br />