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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 /> N! CD <br /> N <br /> /• E <br /> OWNER Or .k+/n ,f a ✓S fitc. TELEPHONE �/t—�3�-7✓r27 0 <br /> su <br /> CD <br /> MAILING ADDRESS 49aox 63 . ::WaaAie,v A)-/ t t/86 <br /> / 4 <br /> PROPERTY ADDRESS (:t c &V 1 <br /> /l �j fir- �J'� � <_ <br /> J`L /p7 Ly 70�� e1 AdI /of.✓q�(�t fives O 1 a <br /> LEGAL DESCRIPTION(see tax receipt) Zole, <br /> // / 6 �v c) <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ADDITION ❑ y <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a w <br /> STRUCTURE/ADDITIONUSE: ��c /�! LU/i�ASG�K2 0 <br /> '// <br /> (Home/C <br /> abin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: �/!J✓/`/Q/h�D111)'tcCT�S. ' ) <br /> d <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 834 X t1 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> N <br /> �c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p O <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tj Z \ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. o <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. C> Li <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C 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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI MA R/y i <br /> NEEDED. ` I� I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. rJ JAN <br /> 10 W Eo <br /> 0 T+ <br /> CONDITIONS OF PERMIT: 90 tn p 000 <br /> SU)j/q�7� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITISSUANCE. r / C01 'I�I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ZO�/NG v,Y S 0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY w <br /> PERMITTED. (> <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER U <br /> SETBACK AREA. { <br /> 5Cs/U i fe — C rang Cehta — - /6 -u y - 5 i d auk 8/dd' tr <br /> iS 3 - 11 om> vaFm r• <br /> 6. (A)6S Dov' fi'bYn C) �n . LC�e Glass Cl <br /> ►�ec�u (Ying ( off' sGfdaCl� —vtC m cN y s <br /> 7. <br /> Z N COD O O fC <br /> O T G A <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> a >1 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize am o : 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 permit county officials charged with administering county ordinances or other <br /> authorized persgoAo have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> SIGN HERE <br /> (signature of owner or buildin tractor) ( ate) (� , ` o_ <br /> ZONING ADMINISTRATOR69 C E <br /> ' EA EA fA W N <br /> r N V I N N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />