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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 rr` <br /> to O <br /> m <br /> c <br /> TELEPHONE 6OWNER n -0L � L <br /> -� <br /> r <br /> m <br /> � O <br /> MAILING ADDRESS ��' 7 / j7 qui SD. Villpls, „`It. SS'S��7 -�37/ ° <br /> ii r m <br /> 1 O <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) -MOM MdCD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ N ° <br /> c 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> (6 dt� 3 seas. t°v�f� oh s -, T. <br /> STRUCTURE/ADDITION USE: �_ "5Sq ° <br /> (Hope/Cabin;Commercial Business;Bedroom; Deck;dtc.) w <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 9 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Opo y � Z11 <br /> N <br /> CD <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) CL <br /> ?I o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M o <br /> NORTH(N). <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. <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. -IS'- <br /> 5. <br /> S'5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N7 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS O ' <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Op <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 p <br /> PERMITTED. / <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M Nmnm CL:E 10 <br /> m 3 O.iD xnm 77 <br /> 6. v m C0 m o <br /> Z N 0 ° O 0 <br /> 7. c T. <br /> - rn : t m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my G�c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ° ; E» : <br /> aC : ° M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o C <br /> CD <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am w E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or othero <br /> authorized person to have access to the abov described premises at any reasonable time for the purpose of inspection. -n m o <br /> m <br /> ° <br /> m <br /> SIGN HERE j <br /> CL <br /> (signature of owner or buildi contractor) (da <br /> tA <br /> ZONING ADMINISTRATOR M t� d ' `1 'y`— 4` ' ` En <br /> L EA fA fA <br /> N fA N <br /> N a O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 9(l 00101 O O <br /> Q1�� 31 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE G <br /> 3' <br />