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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 PERMTS 3. <br /> ,®t-_ ) bid v, C-A N <br /> / �//ya?l a� <br /> OWNER C h U C S i orI l e / p TELEPHONE 71,5-- 6 2S- 7 t4 4�1 0 <br /> MAILINGADDRESS H r 11 �d, S Pool ci';, ma S-YFO I on II <br /> 0 <br /> PROPERTY ADDRESS _S 1Yl 1 <br /> 1 9 css <br /> LEGAL DESCRIPTION(see tax receipt) !, 7 O 5 eC 3 6� V Paa61-&-L/ c�Q/u R f (� 7✓ cn <br /> 7 I o <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION N <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ C MPING UNIT ❑ SUBDIVISION ❑ q <br /> STRUCTURE/ADDITIONUSE: KI+( o <br /> (Home/Cabin,Commercial Business; Bedroom; Deck;etc.) rn N , <br /> BUILDING CONTRACTOR: T-1 C e C O'!54nj c4 i o n <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O O , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �o M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CA tt03 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Ll <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. P <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, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 -" <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ' <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT R/ <br /> ISSUANCE. ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 4 <br /> ("^I. <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. 11 <br /> r M ft-tV 1yj _S 7h <br /> X f-74e 3a x maa an <br /> 6. <br /> _ <br /> 'O N C y y 0 = 3 <br /> 7. Z N O O O 1 <br /> �I G tl <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm e, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o v <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 d <br /> providing in this application. I agree to permit county officials charged with a�rr{i►w rlr'gc ounty ordinances or other <br /> authorized person to have access to the above described premises at any reasor�a f e1 e+f Wpd*se of inspection. T D o <br /> SIGN HERE � '/D /.1 __... CL : <br /> (s' � <br /> natuef owner or b 'ding contractor) L + _ ( a ) <br /> te a <br /> vi a ZU02 G <br /> ZONING ADMINISTRATOR I L COUNTY��(� ( � \� <br /> � Cl UNT <br /> N O Vt Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRR9@NiNG a <br /> 02g3(oyAc- <br />