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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITSLm <br /> UJ <br /> OWNER CDIJ f LOf�.I L{ -SC;ti TELEPHONE <br /> a�f2 <br /> MAILING ADDRESS �� ( I��U/ �� /��S�U Ll �C / 1��f V S S •� �` <br /> PROPERTY ADDRESS <br /> � W 5�g30 <br /> t�'�ffJu� <br /> C <br /> LEGAL DESCRIPTIONLt+T" I Civ1 1�'CI IZ (cgs fs� -/ � �' LOT g-�(p-ty <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE❑ ADDITION ❑ STAIRS❑ �- <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO❑ DECK❑ 3 <br /> STRUCTURE/ADDITION USE: 01 k 'Z <br /> (Home/Cabin;Commercial Business; Bedroom; Deck,etc.) <br /> BUILDING CONTRACTOR: /k97Q 10A <br /> P°ro <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. I^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 'o & <br /> 6' <br /> Y ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d <br /> I.'Li SHOW THE LOCATION AND SIZE OF ALL E)(ISTING BUILDINGS/STRLICWRES(EB)AND ALL NEW y S <br /> BUriDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> pND INDICATE NORTH(N). <br /> .A! SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) a \ o <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK f�O v3 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. W z I <br /> *!SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES., O� <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> _G/y IF SEPARATE PLANS ARE SUBMIffED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE <br /> T� PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. "n a <br /> g m O Q <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. K <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Y� <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. d <br /> NOT TO BE USED FOR HUMft/fl�L.& JLr"r0 Oti1 HABITATION. <br /> 6. 5-In �2 .n.,l� 0 <br /> b <br /> 7. 9 .Ga S, <br /> I declare that this application(Including any accompanying schedule)has been eomined by no and to the best of my lmowledge , ..w C : y <br /> and belief it is true,correct and complete. I adosmaledge that I am responsible for the detail and accuracy of all information a o g <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognbas tient this iMmmation I <br /> am providing will be relied upon by the Country of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the County of Sinned relying on this intorm ulon I am providing in this application. I agree to permit <br /> county officials charged with admini - ng county ordinances or other authorized person to have access to the above-described S n <br /> premises at any reasonable time for the purpose of Inspection. FC) W y m > <br /> SIGN HERE <br /> (signature of ouni1 lb{gilding contractor) (data) <br /> � `"I�h <br /> �� Vcnp 'vf <br /> ZONING ADMINISTRATOR <br /> B <br /> TOWNSHIP PERMITS MAY BE REQUIRED y' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE S U U <br /> ��+4e-/ l� ILe� � "r0�d fL6 ( ' Lk�Dn 5-Q3-0� <br />