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-715 - 3 z./R - -;t4 -33 W- ' crk- Si,►-� <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> to ° <br /> N <br /> W fo/0-991--. 990 <br /> o <br /> OWNER171Q � �IA �P(' IPIY) S TELEPHONE - �(�i -C�-n�3 p ten` <br /> O <br /> MAILINGADDRESS 13T�� �N <br /> O <br /> PROPERTYADDRESS �2 O5,2 <br /> C�e9 L3 CS�n ✓l S '/l43 ��—�/v / o <br /> LEGAL DESCRIPTION(see tax receipt) R U <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ I (n ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> STRUCTURE/ADDITIONOSE: a " RC C41 /t e <br /> (Hom abin Commercial Business;Bedr om;Deck;etc.) ( <br /> BUILDING CONTRACTOR: I J � �q1 ' ;k2�'+ 'fir YL ° (C <br /> s o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o ` <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o l ly <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C 3 � <br /> 3. SHOW D M)ENSIONS 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 I \ 1 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. I (� <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 0 n\ <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° ° <br /> O E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERqjCATI ZBE W HEN j <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. AU �� "//" o w <br /> CONDITIONS OF PERMIT: pp��� 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS (ISSUANCE. V��` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORT LJ OVNTM <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <br /> PERMITTED. L`J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBAICK AREA. <br /> 5. �U TSIG�Q ��Yn2h dlrb `�i? G1l1 Q �O/71)v � /�✓ <br /> m an d n C n f m <br /> �+ l <br /> 2C& OR T. <br /> 6. �l+/1c1 �� �I��r 9 C y m O = 3_ <br /> Z N N O <br /> 7. o -nQ <br /> U) IT <br /> - A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M <br /> ID <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 I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> : ` <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T ° o <br /> (D <br /> °' <br /> SIGN HERE —off <br /> a <br /> (s' na re of owne r ilding con ractor) (date) <br /> ZONING ADMINISTRATOR <br /> EA EA 69 fA -+ N <br /> L• N (TNNOO <br /> CnCn T TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />