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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> CDE <br /> OWNER GAfL2E7T S. ConlO(/GZ TELEPHONE SIS— S�r+G—FS�8 0 <br /> m1 <br /> ( O <br /> MAILING ADDRESS <br /> 77 / 127=QcFr PASS <br /> ASS 6 <br /> CD0 <br /> PROPERTY ADDRESS 3 Qa ( ftPCLL q 2Q Z-A K.E k'O . Lj Fi Q 57-ee- L-J 1= <br /> sY�93 <br /> fd C�� 3_��- <br /> LEGAL DESCRIPTION(see tax receipt) O �� <br /> 0 <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ m <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> y N <br /> STRUCTURE/ADDITION USE: re k 2q C 6 4t Y TN 9A 6 � 0qd X ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) ( <br /> BUILDING CONTRACTOR: <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR _n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C oillzc <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. P <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 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE 777TYR ! <br /> Y BE DONE WHEN <br /> NEEDED. I »THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. U o w <br /> DITIONS <br /> 1. DRIVEWAY FPERMIT: v1 <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERV 2004 <br /> ISSUANCE. g�'1 /— <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALOr$,WyE -COUNTY <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLZONING �► <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD w m 0 a F M <br /> 6. m 3amw M <br /> CD C y m 0 7 <br /> Z g m 0 O 0 <br /> 7. o T < E m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m 3^�' 0 <br /> PP ( 9 Y ) Y Y E c : `• C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? a» `. ra <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> m e <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- G) <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 m <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 described premises at any reasonable time for the purpose of inspection. m <br /> -n Eo <br /> v / iD m <br /> SIGN HERE <br /> (signature of ownj!r or building contractor) (cr <br /> ate) a `• <br /> e yrJ i t <br /> ZONING ADMINISTRATOR <br /> � 1 cNio• o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />