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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator ci Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> o � <br /> N <br /> OWNER ��/�d L F� �. C)Q /T SU TELEPHONE S/- 7 'O _9i5� 0 CS <br /> 3 yi on �t7lb �� m C <br /> MAILING ADDRESS <br /> r m <br /> PROPERTYADDRESS /yg Lp A/�y G/�/riE.QO/� �//¢�✓�r✓ (`/,' S S�3'3d I <br /> LEGAL DESCRIPTION(see tax receipt) 5g T�t 1Y SGPT TT rsc✓A 5�(�� C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION rn O <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO ❑ a <br /> < a <br /> ' IB / cnd�y y0STRUCTURE/ADDITIONOSE: ern �rL <br /> (Home/Cabin;Commercial Business; Bedrdom; Deck; etc.)/) E I <br /> �v� CA-dn✓ <br /> BUILDING CONTRACTOR: 041 <br /> i Y' � / G.QcSRI L/9�r� �— <br /> � � N <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. <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 11 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I 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 d <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Q� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS -4-- ,02. ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. F _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN w �, <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 <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. /� /l n' n , I,, , <br /> 5. nosi-� ` C, _ (,/n/'Cj `C l,� f�a m m F m <br /> 6. � //7J I OWCyy 073 <br /> 7. Z R O O fG <br /> 1 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 E C ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E m ' G <br /> that this information 1 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 Coun �;1;. tion I am <br /> providing in this application. I agree to permit county officials charged n t �'a o or other m <br /> authorized person to have access to the above described premises ata h u REpection. m m ' C'• <br /> m i m <br /> SIGN HERE to f E i <br /> (signatuYe of owner or building contractor) JUL Z (datej a <br /> ZONING ADMINISTRATOR yy/`IE °+moi• <br /> (�( TOWNSHIP PERMITS MAYBE REQUIREDZONIN <br /> ���THfS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />