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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS . < <br /> r ..D <br /> o <br /> m <br /> OWNER L p(. �' 9. � TELEPHONE [ 15, n <br /> m <br /> c 5r MA) Syl lr� o <br /> MAILING ADDRESS f l/n\ t � <br /> CID <br /> V CCA YA+ L ri O know a add ns <br /> PROPERTYADDRESS n CP <br /> n c� a _ ` <br /> LEGAL DESCRIPTION(see tax receipt) ��� Ib seaman� pin\ U <br /> DWELLING/BUILDING ❑ GARA TAC SS R STRUCTUCL RE ADDITION Vltl 2f�3yel u>J 410 <br /> TYPE OF PERMIT(S): LLL Kk <br /> FILLING/GRADING ❑ CAMPI GUNIT ❑�,ySUBDIVISION ❑ �O'r Z�II� Z nQl <br /> STRUCTURE/ADDITION USE: r7 O x I O U 1 KA-P i I7L(-t) °J C� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) w <br /> 2. <br /> BUILDING CONTRACTOR: L E)c42rior5. <br /> CDC <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> A w <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Xa <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF U1 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. U; <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o.� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 5IT <br /> — <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> NOTE: BUILDING/STRUCTURE 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. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> co 0 <br /> CW 0CDQom <br /> 6. m x3 <br /> 9 p (D C <br /> - m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m � i 10 <br /> PP (' 9 Y ) Y Y G') � C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w �_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 0 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> CID :3 <br /> authorized perso o have acce s to the above described remi a at any reasons I e i ctl n. m a <br /> CD aE <br /> SIGN HERE U�" a <br /> (si a�tt�uret-of ow or building contr c t date) ? o <br /> ZONING ADMINISTRATOR ou 1 G 2004 11 <br /> N " <br /> TOWNSHIP PERMITS MAYBE REQUIREDgURNETT COUNTY t�1 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU7AnG���wwlI'G <br />