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Burnett County 7410 Co.Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> r <br /> y O <br /> OWNERJ&< & !&ELEPHONE �/ j�0 7S7 S p <br /> m <br /> MAILING ADDRESS 30793 740 .o�%�ee � Z&Lr .S el 3U r <br /> ° <br /> PROPERTY ADDRESS 30'793 6h /,2! e o Llbu,��,. CMZ <br /> � <br /> LEGAL DESCRIPTION(see tax receipt) ���77(( ' 2- m <br /> / m <br /> DWELLING/BUILDING 56 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ N > �- <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o <br /> STRUCTURE/ADDITION USE: CIOM MCA0-Lt/ 4I ROS/AJ&S S 3a IV y!; � R. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) rn i <br /> \ <br /> BUILDING CONTRACTOR: 4N` SO A/ w <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 1I fN/i <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> :3 v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m �0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. qjI <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 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN y o <br /> NEEDED. 0• r� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: • <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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. <br /> D r D O D 0 <br /> m m m ° m n F m <br /> 6. Ro <br /> 3 nm x �' � m <br /> _ <br /> N C7. m °: 21� : i m <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 G)2 ; , C <br /> )i <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i'u ° : v,; <br /> a v M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 sn <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m m o <br /> �7 L/ m m : <br /> SIGNHERE / _Q T E <br /> 17 <br /> (sl atur of owner ui ding contractor) (date) 1pOa i a <br /> ZONING ADMINISTRATOR G <br /> p�j ro(N ro fA)N <br /> U TlJ/✓1 N (J1N NO <br /> W}� <br /> /) TOWNSHIP PERMITS MAY BE REQUIRED 0 CA o (" CA O o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />