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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> N <br /> C <br /> I /— N <br /> OWNER Lk A � ✓ n TELEPHONE 46:,P 721 al 1/0 d � <br /> O <br /> MAILINGADDRESS 3 2 I�• i �� cvld. m <br /> 0 <br /> NPROPERTY ADDRESS fi <br /> Cony /,�Sy�/riy <br /> LEGAL DESCRIPTION(see tax receipt) 0 13 5 L/ C N/ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION c 0 4. <br /> TYPE OF PERMIT(S): <br /> n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < p <br /> j N <br /> STRUCTURE/ADDITION USE: rA / r) /Oi/�j /&"04 n -Z' <br /> (Ho�' <br /> ; (36mmerclal Business; Bedroom; Deck; etc.) ( <br /> / 1r � <br /> BUILDING CONTRACTOR: U <br /> � J <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 p <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ' ce� O <br /> ;a H n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> m ti 3 <br /> 3 .SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO a <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. r 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N �J <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. 0i <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN _q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT \ pS <br /> ISSUANCE. p� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYPERMQ <br /> 4. NO TI UCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. m C W 0 0 0 a o v <br /> mxm Ox LL <br /> 6. 9 n <br /> v o C N ; <br /> Z 00 i <br /> 7. o m -ri : m� <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my zz zz � O <br /> PP , 9 Y ) Y <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of �� n �2 "' Ex- <br /> all -1 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize [ m c : m re <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- [ O� <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m ; o <br /> providing in this application. I agree to permit cou ty officials charged with administering county ordinances or other m <br /> authorized person to have accessA o ribed premises at any reasonable time for the purpose of inspection. m ' `° 'n <br /> D . 5 <br /> SIGN HERE <br /> (Si a "a(ujW4?Le<vner or building contractor) (date) t� i <br /> ZONING ADMINISTRATOR `-' 'm ` "" Q/'l <br /> �ZfrY, t I l�J b <br /> TOWNS IP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />