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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> w O <br /> N <br /> azo - (�s�i X1-1 Coz- a <br /> OWNER a TELEPHONE t –ct C Z o <br /> a l q m.�\ 5 377 Cra"i o <br /> MAILINGADDRESS <br /> PROPERTYADDRESS C-1) <br /> 501�"IVO( � 15W c lG' Svvw � <br /> 1' 2— (jJ w 1 <br /> LEGAL DESCRIPTION(see lax receipt) '2—4,o^ is'— O – O - in GQ an lOC�71 - �6l –I <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION R 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTUREIADDITION USE: G —t a\r•� f e r`� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (D <br /> BUILDING CONTRACTOR: <br /> Z � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 5e'e UGC rldA.c'e 1jr 3 O y (") <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) V 'F r ��L )ry ?5 t st /r O a v <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C v n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. A� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. \ o \ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° (� <br /> v <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. �/� ,/J (�® <br /> 5. OA)b STY `7,( PM.��/h s dA-lc Ay' -- -101/ ,Std f✓^- �1-'/�®✓M� / A co O r- D v D v ''a <br /> (f P" Ll'zl rct�'38 m n m a <br /> 6. / m Foam ; aA <br /> Z c to 0 0 <br /> 7. O N TIS <br /> 4m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my [ �j <br /> : A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d �_ C <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> G <br /> PP ( 9 Y ) g <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. ; G): J <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. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person t ave access t above described premises at any reasonable time for the purpose of inspection. <br /> / m n <br /> SIGN HERE contrac <br /> gna re of r builtling tor) (date) .`: o <br /> ZONING ADMINISTRATOR <br /> 1 O N U W W N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v o v u u o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> fermi 4- Limber sent -dD Cha-1q 0al'ybe l to-r 5 <br />