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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ 0 <br /> 0o <br /> APPLICATION FOR LAND USE PERMITS ' <br /> N O ^ <br /> C ' A <br /> ,, // //// <br /> CD <br /> OWNER f1 ft QJ-A, f 'C (J 19&aY'd TELEPHONE v <br /> O <br /> MAILINGADDRESS .J�lt'y /1/0)-/4 IUOOO/ �(Jr ��r�4' � <br /> 0 <br /> PROPERTY ADDRESS 3 0 6 a {J A S U f <br /> G <br /> U)C9rn U l5 % `J <br /> LEGAL DESCRIPTION(see tax receipt) Of f e)7 S C C �� �/� // �7 0 0 ¢ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® Q <br /> TYPE OF PERMIT(S): a <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n /1 <br /> STRUCTURE/ADDITION USE: K�h SCYCGft dhc�i <br /> �Ierrn&' P" C�GOSE1L Lao ° <br /> _ L �/�•�1� (Home/Cabin; Co mercial Business; Bedroom/; D/eck; etc.) �— m <br /> BUILDING CONTRACTOR: C <br /> CD G <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C L ��CIx J � c <br /> J nn � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 70"a��o T O Z <br /> J. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ATE m ° A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICJ ` o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �3a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF _ o <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 O <br /> BUILDINGS, ROADS, LAKE,LOT LINES. ` <br /> S TO BE GRADED OR FILLED. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAN F� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> I <br /> CONDITIONS OF PERMIT: Q <br /> t,l <br /> 1OQ. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Y <br /> ISSUANCE. 0 t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. r- DODOm <br /> CD CL M 0 m <br /> m x32. n � am .'D <br /> m �c <br /> 6. o � cyyOj3 <br /> Z C N O <br /> P m T < ' m <br /> 7. = v E <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 L' <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n � ;a <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Zr <br /> o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information lam tel€ <br /> providing in this application. I agree to permit county officials charged with ad_mi r' i ther <br /> authorized per to have access to the above described premises at any reasq f P U In. -n E <br /> m <br /> m n <br /> SIGN HERE <br /> (s' ture of r or building contractor) OCT� L^ ^ <br /> t [ r�o"--001 <br /> ZONING ADMINISTRATOR ✓ ` ` ` ' fA fA <br /> fA fA EA ffl- Nu -91 mar L a° BURNETT COUNTY �o C M o� TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE ;ZCrEUAN .�� �� p- <br />