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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator M 0 Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> 5T 0 <br /> /^ r �� <br /> OWNER n <br /> � fJ a ��q� t�e�✓Fr� TELEPHONE b / L �' L,�J <br /> MAILING ADDRESS C7L� l5 i:ay e- Ave , Vio Fe y 1 et-0 A yl I : 0 �� <br /> PROPERTYADDRESSAdl <br /> o <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) �_ U �►� <br /> 1�yI <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ t; rn o' <br /> y.� <br /> TYPE OF PERMIT(S): c 1 i <br /> FILLINWGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ��1 %� a <br /> � <br /> ` - So!� < 1h <br /> ' ' , <br /> STRUCTURE/ADDITION USE: ky x Jo a a s 3a <br /> o' <br /> (Home/Cabin;Commercial B,ur/siness; Bedro m; Deck;7-CE <br /> ) cn <br /> !T <br /> BUILDING CONTRACTOR: ('U w e d - ®(- y^ <br /> i 4 <br /> v _ <br /> m <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. TO <br /> M y C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o G <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. i C) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT I¢T77F p NE WHENNEEDED. J J f�JTHIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. VCRTo <br /> oCONDITIONS OF PERMIT: �AY 1 92004 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS PER�MIIITISSUANCE. � (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG S B N977 CO �) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONING <br /> NTy <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. lN,/ <br /> 5. — CI hLC C ID rn ODt7rn <br /> m >vmO0 m <br /> 6. m 3aDx° m ]0 <br /> m C <br /> 7. Z y m o <br /> o <br /> T'< i : M <br /> = m: m <br /> I declare that this application (including any accompanying schedule)has been examined by me and tote best of my 6::r O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail anaccuracy of d o in: C <br /> CL � : cn • <br /> all information contained in this application(including any accompanying schedule)and I further declare th t I recognize m $ o my <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining hether to is- <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this inf rmation I am m E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to ve acce!n to the above described premises at any reasonable time for the purp se Of inspection. m o <br /> m i <br /> CD <br /> SIGN HERE <br /> (signature owner or building contractor) (date) n i <br /> ZONING ADMINISTRATOR <br /> �l/'r`1n , 1 V{ �'C/� v fA fA fA fA N <br /> 1��(}'� I � (NI, OfNI, CNnOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ,� 14 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />