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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> GIL � 378- g5SY C <br /> a7c Swa�Sdn 7l Ya- y 3yr <br /> OWNER TELEPHONE <br /> OS�D OIG /� JI �yA 7 v <br /> MAILINGADDRESS U 3�/ V�0 tvlll� 1w SSKI <br /> //�� � 1- <br /> PROPERTYADDRESS Z$O 3 , h Oft o QVC k IU W-T, 5-ySl <br /> LEGAL DESCRIPTION(see tax receipt) / L? L�l'1 i j U/ 2; CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ! G [A 0 <br /> TYPE OF PERMIT(S): (/�� <br /> FILLING/ RADING ❑'f__`-'CAMPING UNIT SUBDIVIS ON ❑ a C/) <br /> STRUCTURE/ADDITION USE: {CG 1 t o X/ 5 7 M V J <br /> h Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> ® w 1Vorc <br /> m <br /> BUILDING CONTRACTOR: w <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CO <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m C> o <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 9 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 00 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o a j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o p <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 Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK <br /> AREA. <br /> 5. J A <br /> e t. a ✓ �lt� ()NS r�f c✓A5 7�r� . t�f- <br /> n n a F m <br /> CD � D am <br /> Z C N CD O O 1 <br /> o m Tom : T <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — - A <br /> PP ( 9 Y 1 Y Y (j C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a) N <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m to <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am I m o <br /> providing in this application. I agrefi to permit county officials charged with administering county ordinances or otherCD <br /> authorized person to hayp access t he above described premises at any reasons le if' : fD <br /> -n a : <br /> rl m <br /> D : <br /> SIGN HERE LJ v> a <br /> (SI&Atur of owner orjouilding contractor) (date) ` 0 <br /> ZONING ADMINISTRATOR ^1 DEC ' <br /> k�lz ' <br /> I- -4a9-98a /391 EkrYC4 � yS--qolols n 1�� ERMITS MAY BE REQUIRED BURNETT COUNTY w�" al 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA?R&ING C <br />