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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator -0 o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> N ° CIO <br /> fb <br /> CD <br /> CL <br /> OWNER G0-4 ¢' 7orll/ R qGr(! -V Z TELEPHONE ' � 1/S72 D o <br /> CD 0 <br /> MAILING ADDRESS 3 y y6 I /�D Lti (�fgCh k S �✓ Pr;�w- 4441'G /&J,l SS <br /> r � <br /> 0 <br /> PROPERTY ADDRESS 014 q 0 Pp�Gr U/J R ptl� OGI11�N rY �� <br /> ( P) a -N I(o -ofo -s 15-66-01300R,b( s � <br /> LEGAL DESCRIPTION see tax receipt) U' l k/i6 to)-3CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE . ADDITION ❑ (n 0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNI SUBDIVISION El/ 4 <br /> STRUCTURE/ADDITIONUSE: S'jo rQG 6 �❑� �b <br /> HomelCabin;Commercial Business; Bedroom; Deck; etc.) U) <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O N <br /> N a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Myo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). vi 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <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. p <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <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. 0 0 <br /> � o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI D REN- <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. y ` + ,o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMII"pp U// <br /> ISSUANCE. NFf? / <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. tl,Zj# F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY NflyG Lel <br /> PERMITTED. (� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential M 0r ao <br /> o a v v <br /> 6. garage/storage only. Not to be used for human 0 v vo "MD a * m <br /> m 3x = W <br /> habitation. z ° m <br /> 7. <br /> o m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m —r^ ' �' fJ <br /> PP ( 9 Y ) Y Y "n c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of ro n <br /> all information contained in this application(including an accompanyingschedule and I further declare that I reco nize m m mt7 <br /> PP ( 9 Y ) g <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 amL�c> <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o <br /> M : to E <br /> authorized pers to a es to the b e described premises at any reasonable time for the purpose of inspection. T o <br /> CD <br /> SIGN HERE -5 L5 a <br /> (jignaiure of nor or building o tractor) (date) <br /> ZONING ADMINISTRATOR <br /> Y i 5 J TOWNSHIP PERMITS MAYBE REQUIRED I }� <br /> 'THIS SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />