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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 PERMITSca <br /> . ` <br /> N <br /> _ <br /> W <br /> y <br /> OWNER -.J d C Q �r/ TELEPHONE S/- 7 j 7 a (•0 p e <br /> ° <br /> MAILING ADDRESS m <br /> PROPERTY ADDRESS /V bri e s LouCe 'fes•- a <br /> hof Lo Std l �/ S� //y S 7 37 , <br /> LEGAL DESCRIPTION(see tax receipt) C S l)'1 UDL <br /> n <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ' 0 <br /> TYPE OF PERMIT(S): ❑ �/ (f4 `b a <br /> L NG/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION g,/ <. <br /> ( d O/ o E 3�� x 33 .- l IP-rel t4J)� to /, <br /> STRUCTURE/ADDITION S °(Home/Cabin;Commercial Business; Bedroom; Deck;etc.) mBUILDING CONTRACTOR: C- L -IV 4J ss �C <br /> td <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> „ � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o� <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. nj <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO n` <br /> BUILDINGS,ROADS, LAKE,LOT LINES. 1 w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c 1 Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. \ 'v ° <br /> > v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI ONE WHEN O y (1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> ` iV�l `93 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF <br /> ISSUANCE. F O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE IN Co <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �/�/� �/V <br /> PERMITTED. <br /> NC <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD wmD <br /> cima m <br /> 0 3 6 . x° m <br /> 6. a co o <br /> y o i o � <br /> 7. ? rte : m <br /> O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a a '. <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize m o M <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 E i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o : : <br /> authorized perso ave access to the ab scribed premises at any reasonable time for the purpose of Inspection. m m o <br /> /'/9 03 m ` <br /> SIGN HERE m <br /> (signatur caner or In o tractor) (date) <br /> n <br /> ZONING ADMINISTRATOR m 0 E <br /> fA fA ro fA�+N <br /> wl � I ' �� NST N N OO <br /> rn 1 I//1/ '71�V1 ^1 Ut O(/i fT O O <br /> 1 l 1�_ OWNSHIP PERMITS MAY BE REQUIRED lJ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE '� <br />