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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 PE,3MITS <br /> N O <br /> N <br /> C <br /> OWNER S f+ e' /(�e Pr �I J f/� TELEPHONEz 3�Z. 3Q✓(/ o " 1 <br /> T / C 0_ O <br /> MAILING ADDRESS O L y r m <br /> r /� l / Do <br /> /� ] /_ �" 2 /� <br /> PROPERTY ADDRESS f'7 r6,A M r j til o�1J okom 17✓I - Dori') 4l6 l��j &�'If y)(' -o <br /> LEGAL DESCRIPTION(see tax receipt) "AVejt/ul N0 'y t.�J "�� '�� J^ r"� y CD <br /> // �/ a <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE L� ADDITION ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ElZ <br /> STRUCTURE/ADDITION USE: �i C D a t r( aA Qp .,, ea <br /> (Home/Ca ;Commercial Business; Bedroom; Deck; etc.) C ^ <br /> BUILDING CONTRACTOR: Af <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 71 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a J <br /> it O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> Co <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q Q <br /> BUILDINGS,ROADS, LAKE,LOT LINES. ` n` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C N xJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTC.,THE PLANS 0. d <br /> MUST BE SIGNED AND DATED BY THE OWNER. lvJ l`1�./ �-�,} 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC ON MA : <br /> -.f <br /> NEEDED. Ma I- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ` 02004 <br /> `, P U <br /> CONDITIONS OF PERMIT: BURN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZOA, ACS O(f fvCF 0 <br /> ISSUANCE. N/NG ,o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. l>1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 <br /> SETBACK AREA. <br /> 5• This structure to be used as private residential m m > 0 a f m <br /> 6. garage/storage only. Not to be used for human �. ' a y y a T. 70 <br /> 9 <br /> CD y w (O <br /> habitation. Z N „ o s <br /> 7. o -n i m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m 3� 'I O <br /> PP ( 9 Y ) Y Y [� L7 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ll ? 2 y <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize 1: m a <br /> PP ( 9 Y ) 9 <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 I <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have acc to the above d ribed premises at any reasonable time for the purpose of inspection. : e, E <br /> m o <br /> s=a -ay � d <br /> SIGN HERE f <br /> (signat f owner or buildin ontractor) (date) ( a <br /> 1 Uj: <br /> ZONINGA71NISTRATOR <br /> 1 �e (� coa <br /> �(�--- TOWNSHIP PERMITS MAY BE REQUIRED sy, <br /> ,�1 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O ✓� <br />