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Burnett County 7410 Co.Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER S fr yg 1 H TELEPHONE /+�� <br /> m W <br /> MAILING ADDRESS �y¢�/�S, !'� 6�7��/33 o f <br /> PROPERTY ADDRESS ;5)07 C L.g m ski c l L ten 6r ^ <br /> i <br /> 20/126 (ova )5Sd' S3�/f39� l6ly ffC GS- NOD _ <br /> LEGAL DESCRIPTION(see tax receipt)a 9- 6 �-5 0'500V OZ7Ub ( j 60', 7-y LOTJ) <br /> DWELLING/BUILDING ❑ GARAGEJACCESSORY STRUCTURE ❑ ADDITION rn <br /> TYPE OF PERMIT(S): I /� Cr <br /> a J <br /> FILLING/GRADING CC,�A,M�PIF-1 iK <br /> El _NG UNIT ❑ SUBDIVISION <br /> Jj <br /> STRUCTURE/ADDITION USE: `�I^" ' - n (/i <br /> (Home/Cabin;commercial Business; Bedroom;Deck;etc.) d t <br /> BUILDING CONTRACTOR: zozyf <br /> 1 <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 r <br /> 71 U) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> ?I O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m� :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> CT- <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <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. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' f <br /> o � <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 /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p/ <br /> ISSUANCE. l� <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 AR/ <br /> 5. tPOti �5e& Cc� � <br /> (� W00mnF m <br /> 6. m 3o. mx° m � <br /> N Cy7. O <br /> Z y 0 O 7 0 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - r^ 0 <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'n r, (A : <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m 0 mCD <br /> t7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am ` m <br /> providing in this application. I agree to permit county officials charged witfj*dlIy�wt c- unty,ordinances or other o ' : <br /> CD <br /> E mi <br /> authorized person t have access to he abo described premises at sh rias abTe,tgrjte tl� u pose of inspection. ? , : , o , <br /> J CD <br /> S : <br /> SIGN HERE <br /> CL : <br /> date <br /> ( gnat re of or building contractor) ' tL A00t ( ) <br /> l <br /> 1 L W <br /> ZONING ADMINISTRATOR ill 081209 <br /> 3Ui9NETT COUNTY (fin N NiTOWNSHIP PERMITS MAY BE REQU ZING 303 u, 0 Ln u, 0 <br /> 5V'1 F(IS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �3�� <br />