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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER `` ca <br /> c <br /> E!o/i� s re l�1f�P.ArZl'T TELEPHONIk\j, 1(e3 Sia (05340 n <br /> MAILING ADDRESS m OC <br /> Q�1 (ZL�A I�s , 1�1 tJ SS4�� <br /> PROPERTY ADDRESS �$ 3 — ��- <br /> �- <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) w T LSM 9 \ <br /> o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 9 ADDITION <br /> CD <br /> TYPE OF PERMIT(S): ,j � o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ l]+ P <br /> a <br /> STRUCTURE/ADDITION USE: A� <br /> 2 0 1 <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR:�OEP c�.��tn�� <br /> CGT'\n►�l _\©�l NtYL'�N �SCA2 lAw1L= a. <br /> moi, c_rtot k Fay wl S ba.A -1 -A%3 - 900 <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) <br /> O m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> LAKE,STREAM OR RIVER CENTERILINE OF ROAD, CAND IMEASUREM MEASUREMENT W TLAND AREAS.REMENT TO THE DINARY HIGH WATER MARK(OHWM)OF I (n Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ' I P <br /> BUILDINGS, ROADS, LAKE, LOT LINES. ) <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR F D. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER CONT o <br /> MUST BE SIGNED AND DATED BY THE OWNER. / C.,THE PLANS 0 <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE ' O <br /> NEEDED. / r o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT. J 9 'o J�+ <br /> 1 SSUAWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT2. �C�cO ��✓ C <br /> 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 i <br /> SETBACK AREA. <br /> 5. Sem C,t e9 ock11-Me <br /> 6((We C m wm, vDv � <br /> 7. �r V 3 a y x ;z <br /> m C H o <br /> Z <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o T< ' p <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of : w 0, , <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem E m <br /> o : <br /> t at this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 m 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. <br /> o <br /> -n o i <br /> SIGN HERE , �0 m <br /> (signs-y[iof own or building contractor) <br /> (date) n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />