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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _U Q o <br /> APPLICATION FOR LAND USE PERMITS . <br /> /11 '5O -5o JZjr- (aSl as3- Cc,aY 'ce-cc �Z <br /> a <br /> OWNER k6 a w-i XEc-K.try G 6� TELEPHONE <br /> d <br /> m O <br /> MAILINGADDRESS ya S L N 11<K Pit t�04,�E S u,TC (ap MEn/po 1 tl HF/"STs /}li✓ S'S'l 1a <br /> 0 <br /> PROPERTY ADDRESS 6 96 L� I\o�}p t W t'gS h'� W S S y S 9 3 , <br /> Loc ru <br /> LEGAL DESCRIPTION(see tax receipt) (,p t G $/h ¢3}(o, l/, a 1 (�G • A(� (o)S69 LoT b a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ to <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING Rr CAMP I G UN T ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: in I ° <br /> n ( o e/Cabin;Commercia usiness; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: ScDr <br /> c' EcK 7/S- g66 - gyy7 woQK 7/C-'790 - 7gg7cc�cc <br /> v <br /> CD <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'k X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. t <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP V71E:W:)> 0 a <br /> '—t v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. D D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. <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. <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,CONTR ETC.,THE PLANS ?. o 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. j cZ 1 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIQ MAY ° -Q, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. NIS <br /> �� <br /> CONDITIONS OF PERMIT: O <br /> P <br /> 1 SSVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> �O'; U� INN <br /> 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Y ('COj <br /> 1 <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. e <br /> 6. m 3 a m x 2 9 a m <br /> O m C y N O j <br /> 7. Z N O G G <br /> ° "�` m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my <br /> r^ O <br /> PP ( 9 Y ) Y L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ° f <br /> a cn • <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : 0 me <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. 1 further accept all liability which may be a result of q }� n tlZis information I am m <br /> providing in this application. I agree to permit county officials ��d th i #dinances or other ' E <br /> 1 m rn <br /> authorized person to have access to the above described premis or r se of inspection. - c <br /> SIGN HERE 61 �' <br /> gnature of er or building co act6f date) a E <br /> ZONING ADMINISTRATOR ; ; � `• <br /> �� <br /> 77nnNINN " (n(ft ro N <br /> �Q TOWNSHIP PERMITS MAY BE RE E13 <br /> w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />