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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 0CD. <br /> !n (� <br /> I^n n '7 C �J <br /> OWNER �Il/L.J�� yyt,n ,QHS <br /> TELEPHONE <br /> 074 / �j�f <br /> MAILING ADDRESS 'rte vc-L I •l�/ &//� 10 ^ r r <br /> • . > O =o(� <br /> PROPERTY ADDRESS Nuc L1c o <br /> r�r sw y �� �y w01 <br /> LEGAL DESCRIPTION(see tax receipt) cn <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE IAF ADDITION ❑ <br /> 0 <br /> TYPE OF PERMIT(S): C <br /> Cr <br /> FILLING/GRADINGlCAMPINGaUNIT�C❑+ SUBDIVISION <br /> ) � n <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin;Commercial Busin ss; Bedroom; Deck; O <br /> etc.) m <br /> BUILDING CONTRACTOR: / \ GV CC� C( �l�S� � n <br /> .17 -CD <br /> J <br /> v 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 �G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> :n v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 `3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 7 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N (f <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS Y <br /> MUST BE SIGNED AND DATED BY THE OWNER. O ` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIP EN a o <br /> NEEDED. / �� � Vl <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Jt'f <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE((JJppRAAf11 ISSUANCE. d / G <br /> CUTTING2. REMOVAL OR LIIO�/ryV�V7� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY FICALLY ^ (_J <br /> PERMITTED. �7 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5 <br /> 6. m 0)� 0, CQFm <br /> m Samw 78 <br /> CN C <br /> 7. Z n 0 i =� <br /> o -n � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (n : : D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of [moi m , ' : : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize p m E f m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D i'") <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 vl <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above desc d premises at any reasonable time for the purpose of inspection. T m Zr <br /> SIGN HERE <br /> ( nature of owDpr or bull g contractor) T (dat ` a <br /> ZONING ADMINISTRATOR ic A-A'L� W <br /> v /Ia fA EA N <br /> /��Ur✓ ��/ O 622 OWNSHIP PERMITS MAY BE REQUIRED N o <br /> C Oy#YQ THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />