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I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS CD 3 <br /> r CAA (� <br /> - - 1 _fit I� _ �/ �1�� _� m m �o <br /> OWNER ;A ,4 r I /a Sia g TELEPHONE /�'7 _lJ� 4 Q,? d <br /> MAILING ADDRESSI,f•�r /, 1 �O� <br /> r�i/ vim-/ r m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) � s�yY /V /y Sem �2q W <br /> DWELLING/BUILDING GARAGDACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING ❑ /goo <br /> UNIT [I SUBDIVISIONgo <br /> ❑ a <br /> STRUCTURE/ADDITION USE: f /)D'AfB. o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: 5�(/Q 1,�:54osaA, Al —S� jl.)%? 1-1-0r„a-,;t <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A7 LEAST AN 6'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO 3' ', C4 <br /> 0 m G <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p <br /> T n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(e) 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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N �J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 C <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> E <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o o T <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Oh <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE, i1 t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY to <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WA?ER <br /> SETBACK AREA. J <br /> 6. �k(sh"5 Ctabt, ka b� L'owt -{-•+'.( Atte S° ud-e 6AA Ir <br /> �1 <br /> �l ! J / f mOrD0D0 M <br /> /Ua {kcjn.aiv /-rR��7�+-�'�'t, C,Set-/�� ✓ x 3 a m 0, a <br /> 0 0 <br /> Z c m m o i 1 <br /> 1 i i m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m G) D <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n u' i c <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- cn <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 a o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person o have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T n : <br /> D ; <br /> SIGN HERE y— <br /> (sig a of owner r b ilding contractor) (date) I i <br /> ZONING ADMINISTRATOR <br /> w w w w <br /> o <br /> TOWNSHIP PERMITS MAY BE REQUIRED C`) ul c01 uWi <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />