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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v c) Z. <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER O)}per T F>zA�J z9->til TELEPHONE -7),5-_ZOS^ &-73 O <br /> m <br /> MAILINGADDRESSfSC. S4-830 <br /> cel /Ii�w2,/v �dw,u opt )wJ,sS <br /> L <br /> PROPERTY ADDRESS OT t V G 1/� O I� F- I ow SE ci'pN 3 y 4 I N 2 <br /> LEGAL DESCRIPTION(see tax receipt) up T V,0--F Pin V V 5' <br /> DWELLING/BUILDING K GARAGE/ACCESSORY STRUCTURE ADDITION ❑ p! o <br /> TYPE OF PERMIT(S): C ' <br /> FILLING/GRADING ❑ CAMPING UNIT E] SUBDIVISION <br /> I Y� b ❑ <br /> STRUCTURE/ADDITION USE: NEW U LA IZ ACrA-E W/ ATTACH Q�> rA�?A67 0-- o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �IOM�S PILE, <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 41 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <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(OHWM)OF i z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. 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 (Tl 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ( 1w <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .� <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W d <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 O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m cpm iu 0 � oD. 0m <br /> 6. 03 no. xa ° A <br /> p CDD C <br /> 7. Z C y O <br /> P N T� <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ �++ A <br /> PP ( 9 Y ) Y Y Lj � C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° <n <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 ? DO o <br /> providing in this application. I agree to permit county officials charged with ad <br /> ministeri c u o <br /> authorized person to have access to the above described premises at any reasonable ... l o <br /> -n n : <br /> C�IkV LJ CD D <br /> SIGN HERE / . n <br /> g ature of er or building contractor) UU f (dto oO <br /> E <br /> ZONING ADMINISTRATOR <br /> S �EA EA f9 EA�N <br /> 13URNETT COUNTY O N OI W W N O <br /> TOWNSHIP PERMITS MAYBE REQUIRED t7Cn <br /> NTNG <br /> THIS PERMIT SHALL EXPIRE ONE ICE RF O DATE FISS <br /> lecbem '4m �inAn <br />