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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'D o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> y O <br /> CD <br /> N C �� <br /> I C A V� C //_ U a CV�!-��t <br /> OWNER L o w L 4 S C if t;,,J V ' \ TELEPHONE4,5-/—1 c2&I— G q� 7 0 - _J <br /> m <br /> CID <br /> bm*0 A or 60 <br /> MAILING ADDRESS N <br /> o <br /> PROPERTYADDRESS �7 00q Ve W yl/Q�l(� a ���SJe� UUrs Dt <br /> C71, <br /> O p pQ <br /> LEGAL DESCRIPTION(see tax receipt) �/Q� S \`l�`d� © (� \ 9�5 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION LJ ( o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a /1 <br /> STRUCTURE/ADDITION USE: <br /> (Ho e/Ca in; Commercial sin ss; Be oo ; Deck; etc.) to C <br /> P W <br /> BUILDING CONTRACTOR: ^ Vl JI 1° n <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O - <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE IT <br /> NORTH(N). y o <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. , <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 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. U1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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 Jj <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X W0r2> 0Qov <br /> > On n a F m <br /> 6. m �c3 <br /> 'o o <br /> 7. o m <br /> = rn : : : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m 0 <br /> PP ( 9 Y ) Y y G) : - C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C ;oo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 0) ::r <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 d o <br /> providing in this application. I agree to permit county officials charged wit (15rices or other <br /> authorized person to h ve access to the above described premises at any le <br /> a i o r dil spection. m 'o <br /> T <br /> c CID m a i <br /> SIGN HERE v a <br /> (si_ gyre of o ner or building contractor) -t (d l '• o <br /> SEP 1 , 20 <br /> ZONING ADMINISTRATOR mIt <br /> LV <br /> BURNETT COUNTY N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING u N v <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />