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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 O z <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 <br /> OWNER C� / U fl-0 /s TELEPHONE 66-1— Z70 -605-1 o O� <br /> m <br /> MAILING ADDRESS d$CrFO <br /> a d SSc 77 3 <br /> PROPERTY ADDRESS 7z <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) f z C M 3 O/ L 3 2. 1 1CD <br /> p <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Q y ,� <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> < <br /> �LL__ /Q //� p <br /> STRUCTURE/ADDITION USE: T� (iG d�/t 0 (�' <br /> /// (H,,00/m��e/Cabbiin; Commercial Business; Bedroom; Deck;etc.) <br /> OPI <br /> BUILDING CONTRACTOR: A O,//C/2/'S <br /> z 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> .O y Ln <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p a <br /> T <br /> n k��— <br /> Z <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 V) D <br /> NORTH(N). <br /> O <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 O Z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N t� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 1 pp <br /> MUST BE SIGNED AND DATED BY THE OWNER. + S c <br /> ro <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> t / <br /> CONDITIONS OF PERMIT: p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n <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. OQ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. p1sr0i mnf m <br /> - m Cw y o � C <br /> 7. Z Om !CA RIfo <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m E O <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n to f C <br /> n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C• : v, • <br /> CD : mo <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 lam ? m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m '• <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> L r m m E <br /> SIGN HERE L Fn <br /> (si nana re <br /> � � o�f o ner or building contractor) , <br /> . <br /> ZONING ADMINISTRATOR J/M � <br /> OX� 93-- / in E <br /> "' 01oE <br /> ocub„- W C u, o01 <br /> TO NSP PERMITS MAYBE REQUIRED BURNETTCOUNTY C <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU <br /> P(z-�-eDl L,1, �dl AJooHa pf t�,I c S I I-/b -o y <br />