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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS �. <br /> r <br /> y O <br /> y <br /> CD <br /> C <br /> 00 <br /> OWNER 4E5 J r',( ®�) TELEPHONE �5��^ 7 L�� n <br /> m K <br /> MAILING ADDRESS ? <br /> 2v I W o <br /> PROPERTY ADDRESS 7, 47 L lA 1 L oS (^p,rya- I C1 <br /> — q / <br /> LEGAL DESCRIPTION(see e tax receipt) /Z I m <br /> M � � <br /> DWELLING/BUILDING W GARAGE/ACCESSORY STRUCTUREXI ADDITION ❑ m > V)TYPE OF PERMIT(S): a <br /> FILLING/GRADING CAMPING UNIT ❑A /� SUBDIVISI N m <br /> STRUCTURE/ADDITION USE: AVC�(f/ <br /> l (Home/Cabin; Commer I siness; Bedro ; Deck;etc.) ( <br /> BUILDING CONTRACTOR: <br /> 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p I n <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a -11 <br /> T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. c <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » / <br /> NEEDED. ��. c <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m mmr0AaF 1 911 <br /> 6. m 3 00. <br /> .(D X= m <br /> (D m C y O j <br /> p y O 2 <br /> 7. o � � M <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m 0 <br /> PP (� 9 Y ) Y Y E L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 'A <br /> CL o Ln . M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determinin%njIDn. <br /> o is- <br /> sue a permit. I further accept all liability which may be a result of the County of I am <br /> providing in this application. I agree to permit county officials charged with in ther m <br /> m : m <br /> authorized rson to have access to the above described premises at any rea - oCD <br /> , <br /> �'7/ N I (D <br /> SIGN HER J l d' <br /> (signature of owner or building contractor) ate) °' <br /> i i i f i <br /> ZONING ADMINISTRATORJ I�� rn (A <br /> ? E ? S <br /> FA 63 fA fA�N <br /> ,1'�f NUI N NOO <br /> �.• .... '. <br /> 0 (n 0100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />