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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator "D o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> o <br /> OWNER1�-ay V- ii �VLV- FDSSV Yr \ TELEPHONE �''L - .3Gi� "J^O' O W <br /> MAILINGADDRESS��2 �� � COLMQ VA Lt CY NIl �J � Q <br /> m <br /> -Z <br /> 11-- A� 0 <br /> PROPERTYADDRESS 3feo5 CO3 A , fV <br /> V�IEP>S'CE�2 J 89 3 <br /> I DT 2 , -SM -* 3cala , v. 14� , P. e4 GO = 7M- <br /> LEGAL DESCRIPTION(see tax receipt) mc'. 4k 2-283 QI o t IN (; \l L Dr[ G 1 C <br /> j CD <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE X ADDITION ❑ <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> ° <br /> STRUCTURE/ADDITION USE: f"Y'T►/.R - <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U <br /> 4&0- Fitt y rbM <br /> �l <br /> BUILDING CONTRACTOR �A I m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/.X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> A � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). rCn 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <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. 9 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. 0 <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <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. <br /> 5. �rls� -a17-0 K Q <br /> X co m m 0 C a � m <br /> 6. m � 3 n m x n m <br /> .o omCyw05* <br /> 7. Z C N N O t0 <br /> O (D -n <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m d 0 <br /> PP ( 9 Y ) Y Y E -4 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize -1 (D m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Cn : t7 <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 o <br /> providing in this application. I agree to permit county officials charged with a o other m m <br /> in . <br /> authorized person to have ces a above described premises at any rea e r e {6 ion. `D <br /> T : a <br /> N > : <br /> 9- <br /> 6 <br /> -p <br /> SIGN HERE <br /> sig ature o owner or building contractor) SEP 2 rZ W) I f I o <br /> SEP L LOtl4 V (/'I � <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY C' 01 O VNT <br /> OOwi (NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />