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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION` F;QR�AN� USE PERMITS �. <br /> �� la5-1- 4 3 7- („Z. 9 b <br /> / I© <br /> �s633 a <br /> OWNER b -� Slic N 5 �� TELEPHONE g� g'Z <br /> o <br /> MAILING ADDRESS A/� (} /� I O J N s Tr l[)e 6 S C- <br /> 0 <br /> � <br /> lr <br /> PROPERTY ADDRESS <br /> /;N9e Ito lves-7- T- OLoN O <br /> LEGAL DESCRIPTION(see tax receipt) ,4&7- 10 Se FFR I Q .5 4-,4/1fd r !� D /�/� 1, AWd L('fD <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE�- ADDITION ❑ ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT -1SUBDIVISION El h, <br /> STRUCTURE/ADDITION USE: pn I Q 5A J? A) �q <br /> (Home/Cabin;Commercial�iness; Bedroom; Deck;etc.) d <br /> 2. <br /> BUILDING CONTRACTOR: ��.0 -,T'2 !A CTId f/ <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/f X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> ;a N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a <br /> -n Q Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). ren <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 7 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 'j <br /> MUST BE SIGNED AND DATED BY THE OWNER. '° O <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN °, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C) <br /> CONDITIONS OF PERMIT: , <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT pQ <br /> ISSUANCE. N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. 3 am xnfD <br /> N C N n O = 3 <br /> Z V, O O �° <br /> 7. O <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my pp `, 3 c <br /> N <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C C" <br /> CL^ : v, A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o M <br /> CD <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. 1 agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> m m <br /> � m <br /> SIGN HERE Z <br /> CL : <br /> ( ' nat re of owne r ilding contractor) (date) <br /> ZONING ADMINISTRATOR <n e» <br /> 10� '.111�T V K)HVr to 0 N <br /> v N p i N N O O <br /> Cn001 cT00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />