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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator 710 70�)Z <br /> APPLICATION FOR LAND USE PERMITS M. <br /> ~ o <br /> N <br /> C ^ <br /> n Q c <br /> OWNER �--"ameS 14) Ga r-- UA k`i J/ , TELEPHONE <br /> MAILING ADDRESS qga (� 1 (s K� �� �j54er g�3 FOS <br /> o � <br /> PROPERTY ADDRESS �Qga LIs Le �jo6S,f[r "1 <br /> —� / 5W NW ex /O �_/ e <br /> LEGAL DESCRIPTION(see tax receipt)SP�AD� a 7 Tow n ` 0jj i/g do B P.5, -WA �S-/ D h IQ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® � e <br /> TYPE OF PERMIT(S): ` c <br /> FILLING/GRADING ❑ CAMPING UNIT / SUBDIVISION El <br /> STRUCTURE/ADDITIONUSE: Four Setts&nS ! tun QoOM ®n PX/sfin� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn J <br /> BUILDING CONTRACTOR: r'O�r Sea!50InS M 40—<)s d <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O y O <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> ?I o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 w 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 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(OF),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. I l <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,Ca T R, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o d <br /> dd d _ F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI� TIONr <br /> fl <br /> NEEDED. �rJ � M <br /> QUG <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ' 8 Z <br /> CONDITIONS OF PERMIT: BURS P �J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITo Q) J <br /> ISSUANCE. 2oly/ (3 U <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. `L <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY j <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> D yw00Aaf In <br /> m CC <br /> LL 3 ' � <br /> D cN o 9 <br /> 7. Z 1 0 <br /> o T,7 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'w E <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am m "T <br /> providing in this application. I agree to permiVounty officials charged with administering county ordinances or other o <br /> authorized person to have accesplo the qqbv*Ueqqj1bed premises at any reasonable time for the4�1purposeof inspection. ' m ` c <br /> SIGN HERE Zy — 7�� • <br /> C <br /> (signatA of owner or building contractor) (date)' J ' a i <br /> ZONING ADMINISTRATOR <br /> _ (/ (A f9• N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> lt�� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> ` 3-7 <br />