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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T Gt z <br /> APPLICATION FOR LAND USE PERMITSLU <br /> 3. <br /> n� /' /��15- (oaU9 ry6s W <br /> OWNER �Fl wl1�K.10E C K�OES6z TELEPHONE (0 1- &33 -7 (00 <br /> MAILINGADDRESS 1 y - I /`{�1 � v NW N� �����'T0.1/ #W-551(2— <br /> PROPERTY <br /> ad� 5�1/ -1 N j <br /> PROPERTY ADDRESS 1 107(oq CP-05S -FO" &) D19 /RAJU/✓ 'rul� lL , <br /> luux <br /> LEGAL DESCRIPTION(seetax receipt) LOj / CSM U 1-7 p14q (620[/ LOTS m <br /> DWELLINGIBWLDING I7 GARAGE/ACCESSORY STRUCTURE L/Y ADDITION ® \- <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRAD��INGpp__,❑p1 �CAMPING UNIT <br /> Ll 1S/UBDIVISION ❑ /_ <br /> STRUCTURE/ADDITIONUSE. I.�ITpFN �[J(.t r)kho",- lW4wr) - <br /> ,ren ue / (Home/Cnabin; Commercial Business; Bedroom; Dark;etc.) <br /> BUILDING CONTRACTOR: (/l.11J I..QIU$Te VICT(f%N <br /> In rk, <br /> 3 " <br /> A PLOT PLAN MUST DE PROVIDED ON AT LEAST AN 8'.X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> a G G9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn m z <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO per <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(BRAND OF z <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. :i <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> W g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE <br /> NEEDED. DONE WHEN g 0 \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Q <br /> S SETBACK AREA. O <br /> 6. A x3 ' A <br /> 7. y Ac„ '" ossa <br /> Z c ” <br /> 41T <br /> 1 declare that this application,correct a any accompanying schedule) has been ponsil etl by me and it the best of my o m: O <br /> knowledge and belief it Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy ze �' <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m $ m <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. 1 further accept all liability which may be a result of the County of Burnett relying on this Information I am a <br /> providing P 9 ' <br /> p gin this a plication. I set e permit county officials charged with administering county ordinances or other _ <br /> authorized parson o v cc the above scrib or premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE 7 2 V 6 D <br /> YWrs a arr: ui ding vontmctor) (dai <br /> ZONING ADMINISTRATOR afmFlay , 'o <br /> d�'uuuei int✓. <br /> TOWNSHIP PERMITS MAY BE REQUIRED C o m o N H N o <br /> THIS PERMIT SHALL EXPIRE ONE YEAg FROM DATE OF ISSUANCE <br /> T-(m�k ,, leuP by LQcuV6rce Knoe6e 'I-Ia 06 <br />