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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator CD- o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> CDy O <br /> fN <br /> �� D 'J C <br /> OWNER 'P Gl�e. .� itL.te, 1 rL.r-SZ� 1� TELEPHONE <br /> CD <br /> (� I ' , �( / , ' L� Q 0 <br /> MAILING ADDRESS O . �X I ( �-•'^ck-,o WT ` gg'33 <br /> �J 'moo <br /> PROPERTY ADDRESS9 <br /> T�Id Ico <br /> LEGAL DESCRIPTION(see tax receipt) („o�"/ Cs/h o26Y tlol l P.��,'7 St r.�v�F l �C] `� r 9 <br /> DWELLING/BUILDING N GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ c� <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ElCAMPING UNIT ❑ DIVISION El :5 <br /> STRUCTURE/ADDITION USE: p(� ✓/�l ZU <br /> (Home/ a ' ;Commercial Business; Bedroom; Deck; etc.) w <br /> BUILDING CONTRACTOR: 1 aU%- <br /> 64001 <br /> m <br /> 5 001 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m -It�) <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C (D <br /> NORTH(N). 0 <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 ) `Q o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. (� <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO XJ <br /> BUILDINGS,ROADS, LAKE,LOT LINES. Q) <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 pG <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VIi"I� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. OR 2 3 I o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM4QTnN` _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR ENE. 'ING uNT y p� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. �• <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK ARE ` _ ^„ • , - 0- <br /> 5. <br /> 5. /�1 �,� p �p � l� / J ((f� v nravavv <br /> ((JJ m 3CLcDX TM <br /> CD C <br /> Z rn m o Ifo <br /> 7. 9 ji'< m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> cW : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m O rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other `• <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> w <br /> SIGN HERE <br /> (signature o r or building cont c (d ) lJ <br /> ZONING ADMINISTRATOR <br /> \ b cwj ;I O rac" N<AON <br /> N U t N N O O <br /> Vl O Vt Cn O O <br /> �� TOWNSHIP PERMITS MAY BE REQUIRED ��,33d aP 7� �tvfr � <br /> ° w—dy�11S PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN� 3 a41A <br /> S' I <br />