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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -V 0z <br /> APPLICATION FOR LAND USE PERMITS 0. <br /> N 0 J<J <br /> 4l <br /> C Cb <br /> D <br /> OWNER on CCQOM J TELEPHONE�5 �7 <br /> r � w O� <br /> h r �j `�,/ A / / A / `_ <br /> MAILING ADDRESS Z�g Z ' V, �GNt2 ��V�U lVd/`I�1 prtl 1IrV SJ/D9 <br /> 'L 202 P-�f-lc 6d. <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) L S C') <br /> TYPE OFPERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONQSE: I h7G.rnJ pw4A4 _ OA1Ue4j <br /> C tid o <br /> � <br /> IS <br /> (Ho a/Cabin;Commercial Business; Bedroom; Deck;etc.) SQ< (nBUILDING CONTRACTOR: I8rX3V CA&, wctk (a'X)g' /Je--� (1400 <br /> C <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8�f.X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. See pe,,,, - # 0U3 a fur Pr v y O W <br /> / � N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m < <br /> CL <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). C 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)OFo <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. � 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. w O <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 �Orj 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 O <br /> NEEDED, n <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C <br /> CONDITIONS OF PERMIT: � <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' <br /> ISSUANCE. c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <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 /> m 10i m 00 m a F fat1 <br /> 6. m S a� xQ' � <br /> m C wo 0 <br /> 7. Z <br /> O -n 3I <br /> =cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myC <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of iu o ; u, <br /> CL u 9 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o my <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am w': <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> SIGN HERE d �' ` 03 ' <br /> (signature of owner or building contractor) (date) �j ` a <br /> ZONING ADMINISTRATOR C ' <br /> oN <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 Cnn 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE t/ E}C �OS Ai'G�QI <br />