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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Ad(ninistrator - 0 0 <br /> APPLICATION FOR LAND USE PERMIT . <br /> r <br /> CD <br /> ) ) n � PHONE SOWNER � S aTELE �^ . o <br /> w `V , -.D <br /> (� O <br /> MAILING ADDRESS 9 a.� �� -�-��� �� � ,-- G•J1 s F?3 r�'ru <br /> PROPERTY ADDRESS /J�d of v j /Ile- 7 1 le - �G� lve- 14 Pit? <br /> o w <br /> LEGAL DESCRIPTION(see tax receipt) (O <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREW ADDITION 11L.(A O <br /> TYPE OF PERMIT(S): {J a <br /> F.►kNN CAMPING UNIT ❑ SUBDIVISION ❑ <br /> LA <br /> STRUCTURE/ADDITION USE: T 14 r - a( o pJ <br /> (Hom abin; C mrmerrciallBupsineess; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 42 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3CNQ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p ` r <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c d <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m j� <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 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(0 WM)OF Z <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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. J <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS O O CZS <br /> MUST BE SIGNED AND DATED BY THE OWNER. - m F <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIOIA�GI Ipp(kY-B D NE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <br /> CONDITIONS OF PERMIT: I APR <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS&F .�ERMIT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHHOR kl couty r t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALL ING <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER t) <br /> SETBACK AREA. <br /> C ' C — i sS L <br /> CD nM 9 ELL M <br /> 6. m 3 a a a <br /> O N <br /> 7. Nm O O� <br /> ° �'` m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to he best of m <br /> PP ( 9 Y ) Y Y G)2 ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail ai id accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare t iat I recognize 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- <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 m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordin inces or other <br /> authorized perso to have access to the pbove described premises at any reasonable time for the purrppose of inspection. o <br /> SIGN HERE O! w w <br /> C : <br /> (signature o or buildin ntractor) (dat ) a i <br /> � /. <br /> ZONING ADMINISTRATOR E <br /> (, fA fA 0 N <br /> QyIS I T� V (NJ O rn'3 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED I�l� W <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a <br />