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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _ o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> A C <br /> OWNER G �G_ _ _O //_��.,_ / GLI TELEPHONE /f���3 -_ ,57 51� <br /> / <br /> MAILING ADDRESS j�x ��3 �� X� � J f/ Q� r O <br /> CD0 <br /> PROPERTY ADDRESS <br /> S , ) <br /> LEGAL DESCRIPTION(see tax receipt) / Q S�DYP m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE <br /> TYPE OFPERMIT(S): ❑ ADDITION 11o <br /> c ' <br /> FILLING/GRADIN ❑ CAMPING UNIT-El SUBDIVISION El <br /> STRUCTURE/ADDITION USE: ot- �P X <br /> (Home/ abin; ommercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: -Ale � �✓S 6. Q <br /> Q <br /> ar <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/5 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a G <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m D <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (ty 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF _ 1 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO y <br /> BUILDINGS,ROADS, LAKE,LOT LINES. 6 a <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 G <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF ONE WHEN o <br /> NEEDED. 4 <br /> t!7��p THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: ApR r` I <br /> ! <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF � p <br /> ISSUANCE. �F / ( W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELITb7-r CQ� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `V�//VG N� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. nn j <br /> m.1 / <br /> �aj7) m 000mafm <br /> 6. CD 3aml0ca � � <br /> N C y y 0 <br /> 7. Z N m 0 <br /> o -n M <br /> - rn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G�, O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w � E v, C <br /> NCL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Po � o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J' <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 <br /> providing in thi"pp lication. I agree to permit county officials charged with administering county ordinances or other Po <br /> authorized pe to access to the above described premises at any reasonable time for the purpose of inspection. Po c <br /> m <br /> �� /y3 o m <br /> SIGN HE i y S <br /> (signet of own <br /> or ng contractor) (date) n <br /> ZONING ADMINISTRATORLl <br /> Cs <br /> fA 0A(A fA PLO( N <br /> � ') Pha N OO <br /> iL TOWNSHIP PERMITS <br /> (, TM THIS PERMIT HALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE9AY BE REQUIREDv <br /> 4�--(U-0 L' <br />