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Burnett County 7410 Co.Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> CD <br /> 7� <br /> OWNER r c �L'/'/Qh h / I-� TELEPHONE <br /> CD <br /> MAILING ADDRESS 1078� y -Pi, t4slG G V {/�A fP/,Mn S�� O <br /> PROPERTY ADDRESS a3�9 <br /> J a ©�[� &/ Si�Gn, <br /> LEGAL DESCRIPTION(see tax receipt) 006— a/Y!G—D 7 —60 �7� <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE El ADDITION IIJ (n <br /> TYPE OF PERMIT(S): C <br /> C7 <br /> FILLING//GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ - -' ! 1 � <br /> STRUCTURE/ADDITION USE: Gab/:, �� s i:a�0�. /Gh oCt Jam/ pooh On a f+J'T�i+ <br /> / (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) d j <br /> BUILDING CONTRACTOR: ` <br /> w <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> W N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ) 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO a <br /> BUILDINGS,ROADS, LAKE,LOT LINES. d <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 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v � L <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 0 <br /> f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o d <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. �nsl to a -O� <br /> M DOi m(Dimafm <br /> 6. 3 'am Fam 7g <br /> ' 751 lD C.N N O <br /> 7. Z y m o ; �2 <br /> P : T" : <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — �' O <br /> PP ( 9 Y ) Y Y L 2 ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- fD l7 <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 w <br /> P P Y Y tY Y 9 C <br /> providing in this application. I agree to permit county officials charpq with administering county ordinances or other <br /> authorized person to have <br /> access to the above described premises qt a reqs able time for the purpose of Inspection. fD ' c <br /> SIGN HER V D <br /> (signature of owner or uilding c tra or) <br /> ZONING ADMINISTRATOR <br /> V <br /> ag3SS- <br /> 69'a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />