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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator 'o G] Z <br /> APPLICATION FOR LAND USE PERMITS <br /> j� <br /> 1 cu ; <br /> bA, 7�. = 66-6 -Y32 w <br /> OWNER �. ,e h K 1 r r Aj 0. �0.1�� TELEPHONE �S/-�Sy'OS7 7 v <br /> m <br /> CD <br /> MAILING ADDRESS <br /> ya 18 QrAn3 rouinJ Lanc-- ra� j. M/jCD <br /> PROPERTYADDRESS a ? S,02 lel ). �11[9Com] 1\iVE1� /�dAb1 . /lCin.I�GLT[, LL.3.L <br /> 1 1� <br /> LEGAL DESCRIPTION(see tax receipt) 8 / R f V f,r .5 OOL Su U. Sex- 7 7-yo K 16 0 rn <br /> e � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE N ADDITION ❑ o <br /> TYPE OF PERMIT(S): C <br /> Cr <br /> FILLING/GRDt•ADING CAMPING UNIT SUBDIVISION ❑ <br /> a <br /> STRUCTURE/ADDITION USE: 1 n e S� C�� ,�/ <br /> O v- S /-I®dr 6si <br /> (Home/Cabin; Commercial Business; Bedroom; k; etc.) rn <br /> �,`,yL C' d s # pis7�3 <br /> BUILDING CONTRACTOR: Y'G Gk Y'1. , � y^^' <br /> m �p <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN B1/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> � z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m A? <br /> NORTH(N). <br /> O <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 . <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. "I I 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. <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 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. -4 11Z5 <br /> a <br /> t7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Un <br /> .-�'» °, ` <br /> NEEDED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ry <br /> ISSUANCE. ll <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. <br /> mm w o C n E m <br /> 6. a Sam Fnm <br /> CD <br /> 7. Cn <br /> o "C . : m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y ) Y Y L7� <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m a : 69 <br /> C <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize m E m <br /> PP (� 9 Y ) 9 , C <br /> that this information I am providing will be relied upon by the C 4forfe <br /> rmining whether to is- <br /> sue a permit. I further accept all liability which may be a res of this information I am E m <br /> providing in this application. I agree to permit county offici t OF a ordinances or other o ' <br /> m : m i <br /> authorized person to have access to th above described pre:;es at any reasonable timeurpose ofinspection. o , <br /> SIGN HERE lCD <br /> JUL_- 6 2W4 <br /> r» <br /> (signature of owner or building contra or) (date) <br /> ZONING ADMINISTRATOR � BURNETT COUNTY G <br /> : _058- 6 o p o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE di JI V) <br />