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OK / 01 '� <br /> Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator _U 0 0 <br /> APPLICATION FOR LAND USE PERMITSCD. <br /> !n <br /> CL <br /> OWNER TELEPHONE va�3 0 <br /> M�jkacl 5l Pei- � ��- _ <br /> MAILING ADDRESS 1 l L{ 1 J3" AV e- 5jj,, �Oa eS-te(- fiI r) SS tDZ. ° <br /> PROPERTYADDRESS a-%,aS CLC-� SKY <br /> LEGAL DESCRIPTION(see tax receipt) �- �L Prr L d p10 �� 7 ( Cl) <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ ((� ( o <br /> TYPE OF PERMIT(S): W c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITIONUSE: Sir \ers Y <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: ` (D4U A hl1✓h L_Ll E��( O bti, , CD <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> 31 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o ,^ <br /> :t v ) Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 av j7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 O <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q/ <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF� TIOId MAY,l3 0Q1 0 o <br /> NEEDED. <br /> v/ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. _ ' Z <br /> CONDITIONS OF PERMIT: 2�/��' P 6 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ZQ�(J UNTV <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. fVG <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY VJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m 3 am Ox m <br /> a mcy � o � � <br /> 7. ZyN <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m � ^� D <br /> PP ( 9 Y ) Y Y C( L7� C <br /> �I <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize m 0 E 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 <br /> providing in this application. I agree to per it county officials charged with administering county ordinances or othero <br /> authorized person to have access tckthe abolv#described premises at any reasonable time for the purpose of inspection. fD o <br /> b m m <br /> SIGN HERE <br /> (signature wn r or uilding contra a <br /> (date) i <br /> ZONING ADMINISTRATOR l 6qjr� <br /> Y fA <br /> 0 <br /> ro Ge N <br /> U N Lq(J, N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED u, o o, o, 0 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />