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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r n <br /> C O /� <br /> y <br /> C <br /> OWNER `�'� \ <br /> GCLL.I �' V ocJt L c�.�� n.?� TELEPHONE <br /> MAILING ADDRESS <br /> .1174 Z:r'li r0JL <br /> sSo1G 9J <br /> PROPERTY ADDRESS g� ��� t k Il'n r S,r c n t-i , <br /> LEGAL DESCRIPTION(see tax receipt) t <br /> Q (D <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION CSI 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIV SI N ❑ a <br /> STRUCTURE/ADDITION USE: �G M• ' )/ R0�r� t}!/� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> � m <br /> BUILDING CONTRACTOR: Z� k� f o S !^r9nSKC IiOn �y�}L <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. m — <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n z <br /> n � � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C ti n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 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 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I oc <br /> MUST BE SIGNED AND DATED BY THE OWNER. o t <br /> o W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z v <br /> CONDITIONS OF PERMIT: ° <br /> O <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. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <br /> PERMITTED. <br /> STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. /� / /► / l l� <br /> t G��61e C(,(t��/rfI G/r /i r d�G 1 �U�/ic.P 4 E <br /> D <br /> 6. m 3 m o � a T��� m � 3 a m OX n � .'O <br /> 7. Z c m o N °� 3 <br /> P m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i p <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m " : C <br /> Gi <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : m i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- U) <br /> pj <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 v W 0: o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. (D <br /> CD .m <br /> SIGN HERE / a <br /> -�y- <br /> / os' <br /> n . <br /> si re of n r or building contractor) (date) o <br /> ZONING ADMINISTRATOR `n <br /> 1�'in in is> <br /> O N C P W N <br /> TOWNSHIP PERMITS MAY BE REQUIRED Co cn o n n <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> rna.t-ieo tD CAWS Z6)m C)rS+r-ikch`oh a-r '©S` <br />