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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator T G Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> Izo3 �S'— ,� c o <br /> j m <br /> OWNERTELEPHONE /L �� t�d O k-10,i <br /> MAILING ADDRESS loip 17 No , `� E m <br /> PROPERTY ADDRESS �S x-0/1 S I S V o m <br /> map-�/3Z 7-6),3- 3OI� Gi 5w tn! Coen sr eb2 -r# A/ <br /> LEGAL DESCRIPTION(see tax receipt) ',S /,V J; 7 7 n ir A 3 / 7Q <br /> hr � <br /> /' <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION El MC V�IPE✓1 CO o` <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADI ❑ CAMPING UNIT ❑ SURDIVISION <br /> STRUCTURE/ADDITIONUSE: <br /> ( ome/Cabin;Commercial Business; Bedroom; Deck;etc.) U) <br /> M -) <br /> BUILDING CONTRACTOR: 2. <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR y= <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 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. Q, <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. O o <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA OZ � N S 0 <br /> NEEDED. J� n f <br /> LU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. APR 2 8 ? 1 oZ <br /> CCONDITIONS <br /> PERMIT OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT / / <br /> ISSUANCE. Z0�I('OUNW <br /> Ty <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NG <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. }j �1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER RJ <br /> SETBACK AREA. <br /> 5. <br /> 71 Or DODO a <br /> 6. m mm00gaE rn <br /> CD <br /> CD 3 am x m >) <br /> mC H o <br /> 7. Z w m 0 : <br /> O --j`7' M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <r ` ' 0 <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 w� `: is C <br /> PP (including Yaccompanying ) g n ` 0 : m <br /> all information contained in this application Includin an schedule and I further declare that I recognize m o : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> WE <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized per t have access to the above described premises at any reasonable time for the purpose of inspection. c <br /> SIGNHERE D��Z�- �' to io '• <br /> (s nature of Aner o wilding contractor) (date) <br /> ZONING ADMINISTRATOR I I I <br /> ^` rA FA to ro <br /> ("�( �j" <br /> pjo� Q �'a�r NO T WNSHIP PERMITS MAY BE REQUIRED `[ N o (" 00 <br /> O O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> a <br />