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Burnett County 7410 Co.Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator "a 02 <br /> APPLICATION FOR LAND USE PERMITSDO <br /> �. <br /> r <br /> F O ID <br /> N <br /> L <br /> OWNER ,T !�1 1 � ``tS TELEPHONE <br /> Q o <br /> W <br /> MAILING ADDRESS 13)8.S ua.Tc✓{ MAS <br /> o m <br /> PROPERTY ADDRESS a g H3 <br /> pC <br /> � Jam+ A <br /> LEGAL DESCRIPTION(see tax receipt) G rcj 6L ' o^f—3 7—lj m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION CO O <br /> TYPE OF PERMIT(S): S�� 7 <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION <br /> ❑ E •-� <br /> STRUCTURE/ADDITION USE: eA-N, f y h12G -'5Gr-S part," <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: <br /> �Tr 5 60ASTr V af�a-% <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In ( 1 <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p CL <br /> T v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C `- n <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 r ^�p <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. lx o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V�� I ISN <br /> NEEDED. <br /> r � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z r. <br /> CONDITIONS OF PERMIT: I Alli _ 6 20i, 0 , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS O <br /> ISSUANCE. _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREU&C CoVNTy vv <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY NG <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. 8 m M3 C) 8 a F m <br /> m CL(OD C » <br /> �N C <br /> 7. Z a 0, 00 O <br /> O n< <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my E O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of U: a - v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �): m $ : c) om <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 I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection m <br /> SIGN HERE '�� �Z5r� g/ 1�cc <br /> m m <br /> (signature of owner or building contractor) (date) o. <br /> ZONING ADMINISTRATOR I rn <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF�UANCE <br />