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Burnett County 7410 Co. Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -D 0 z <br /> APPLICATION FOR LAND USE PERMITS . <br /> y <br /> OWNER TELEPHONE n <br /> MAILING ADDRESS 2-7y 2.-1 9+e> S rg vi. f S YL L�, <br /> PROPERTY ADDRESS <br /> L 3 Cs rn V3 PV d J <br /> LEGAL DESCRIPTION(see tax receipt) 00 Lo Z SE e- 3 3 -T 46 P - 2 1 (e t.J h rn <br /> a <br /> TYPE OFPERMIT(S): DWELLING/BUILDING �fl GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Elc 0 <br /> FILLING/GRADING [I CAMPING UNIT ❑ SUBDIVISION ElD. <br /> STRUCTURE/ADDITION USE: t7 C C r442 pot L-fc Y1YTS ►�� i ! i .3C1 X qO <br /> �T <br /> '3Ct tf O (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> m <br /> BUILDING CONTRACTOR: Wrr-�4 >'a-5 14�rGa✓� <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 00 m C O <br /> m D- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m C a <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. z <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 ttC- 0 C' <br /> MUST BE SIGNED AND DATED BY THE OWNER. W I <br /> F <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT /lJ I U} <br /> ISSUANCE. pJ i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. C± <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> lam►' <br /> 6. OV V m n0, W D> n 0 -0 <br /> 0 (Df m <br /> M <br /> m : <br /> co 3 am xam � <br /> a CD 0� <br /> 7. Z y m D �'D <br /> o n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i q-i O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w 0 ` 69 C <br /> all information contained in this application(including an accompanyingschedule and 1 further declare that I reco nize `• m� a' m <br /> PP ( 9 Y ) g <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Lym <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 C' m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Q, d <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. l 3 s <br /> m o : <br /> SIGN HERE d-3 m <br /> fA in <br /> (signal o owner or building contractor) (date) a <br /> ZONING ADMINISTRATOR <br /> fA EA fA fA N <br /> N( n 0 " (N0 0 <br /> L ys � ��� TOWNSHIP PERMITS MAY BE REQUIRED n <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />