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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -D v Z <br /> APPLICATION FOR LAND USE PERMITS � ° <br /> r <br /> S u ZaA&,C. WIC/lac TELEPHONE 3Yy 64 n CD UPIn <br /> ii7 w <br /> MAILING ADDRESS Aq /c30 LArabee SuLd.u. �� Itse��-ems l✓+S 5 Q3 F <br /> yY <br /> PROPERTY ADDRESS -7'd �2 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Cn <br /> DWELLING/BUILDING �ZGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ '- <br /> TYPE OF PERMIT(S): in o <br /> c � <br /> FILLING/GRADING❑ CAMPING UNIT <br /> II❑ SUBDIVISION ❑ a <br /> S. <br /> STRUCTURE/ADDITION USE: &Lkfjlt? 77t�✓I,�y C�b,p�tf 3a�Y5/0' -�la'X yo` (L o <br /> f <br /> ( me/Cabin; CoMimercial Business; Bedroom; Deck; etc.) coBUILDING CONTRACTOR: Se 04 <br /> w <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> 0 - 7 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M <br /> O m <br /> o- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'nT ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m D <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (f) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC ON MAY BE DONE WHEN o `O <br /> NEEDED. <br /> pA/St�)\ Uer ;4 =THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: y'I a-U ( 7/OUB{ o <br /> Ts Sin Keo r/te4t <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. , O 0 <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 /> 6. m wd> vnvv <br /> maim <br /> m 3 0. c 0am <br /> 7. m C y y o <br /> Z y 0 D <br /> T';� : M <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c r» ' m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> m c, S <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m C 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 j : 0 <br /> sue a permit. 1 further accept all liability whi may be a result of the County of Burnett relying on this information I am m E <br /> providing in this applicati I agree topL <br /> officials charged with administering county ordinances or other w <br /> authorized person to h ccess to th ed remises at any reasonable time for the purpose of inspection. <br /> . <br /> m c <br /> SIGN HERE �/-�a'O m m <br /> g re of owg contractor) (date) a <br /> ZONING ADMINISTRATOR � O <br /> 44e//vwd, NS IP PERMiO N 69 UI N N OO <br /> TOWITS MAY BE REQUIRED 1 <br /> ' THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />