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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> o � <br /> /_ / L CL <br /> m W <br /> OWNER CIA Iq \ e Zio 1A S tc)6 r TELEPHONE ��3 S(o j�(CJ <br /> c,, �/ .�Q/y� m <br /> MAILING ADDRESS //V�6 � � !�t 0� � � 55 I Z <br /> 0 <br /> PROPERTY ADDRESS s- R I VL/2 ~ <br /> fJ(AFL �006 _hfi) Sad+"4J0 <br /> �J �o LuT S Q <br /> LEGAL DESCRIPTION(see tax receipt) �� 3 3� 3 O DIV ] 3�' ��7td � <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE El ADDITION 0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT,❑y�SUBPIVISIONT. <br /> ❑ �. <br /> STRUCTURE/ADDITIONUSE: R I (J - f-1`�L� � �aK <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ' <br /> BUILDING CONTRACTOR: _� Ro n�Rtvl UwyP�2 / <br /> I � � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> ]1 vi <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> 11 O M -R <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 70 7C�� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C3 v <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. I ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO OQ <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I Q c { <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRMTC.,THE PLANS �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. � o p <br /> U CJ 0 = 'I.J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA7 MAY H <br /> s <br /> NEEDED. 1 `� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. JUL 2 8 2004 <br /> CONDITIONS OF PERMIT: �URNET' p,` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT w W <br /> ISSUANCE. ' 4G <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 ARE <br /> 5. 7-frjL4'frs /T � n ,7/av /IJJ� Tb Este ePr��C��J v f l✓✓�! e's <br /> JA3 ro o f <br /> � ru&' e , move�f to mem /a' side yar4 seaa� m q y . o <br /> " �� t fJlJII_� i (d N1 J► �1Jti l# f 10)Ja ud' Over I H <br /> I declare tha this application (including any accompa� g schedule)has been examhUh by me and to the be c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize E m G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is m E <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 t w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> m m i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. c <br /> 7 m <br /> SIGN HERE CIL <br /> �' <br /> (si to dKwne b ding rector) (date) <br /> ZONING ADMINISTRATOR <br /> -fu � ) W W PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANC <br />