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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> to O <br /> N <br /> C <br /> OWNER M rw k �--I�tt-C,�. 1' f rn�'�')-5/ 3)-c)LJ r—,' TELEPHONE o <br /> w d <br /> MAILING ADDRESS 0? n1 13 beeGk S3+ree`r) ��, Pp"I mw o <br /> o m <br /> PROPERTY ADDRESS o2966 <br /> 9 L�� Loki t U1 <br /> LEGAL DESCRIPTION(see tax receipt) /,of q CS 01 V a Pas? PC L &CU Licst I �' -� Cn <br /> _ d m <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ,Vnt (n (. <br /> TYPE OF PERMIT(S): I <br /> c <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑`' SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: DGQk I)t C pd 0. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn C' <br /> U <br /> BUILDING CONTRACTOR: <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR\(,'r T 3. < � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. s y OY �v�^ 1 0 <br /> �6t, N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 6{f b O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF j� <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. v 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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 �I j <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 7' <br /> o � l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN (n <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z w <br /> CONDITIONS OF PERMIT: P w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 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 �Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X W O r D 0 D 0 17 <br /> A j 3 7 0 n a <br /> fm <br /> 6. p N C y N 0 = �-+ <br /> Z C in O t0 .I <br /> 7. OO m T m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> Pp ( 9 Y ) Y Y C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m �^ <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m ( E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m in <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 o <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 i r t' `D Q <br /> m <br /> DSIGN HERE ' S _a <br /> gn lure of or building contractor) (date) 0, <br /> ZONING ADMINISTRATOR -/ �i'Gf 2 <br /> O�EA Vf<A di�N <br /> � ONOOI (WJI Cn O <br /> TOWNSHIP PERMITS MAYBE REQUIRED BURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA$GNING <br />