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Burnett County 7410 Co.Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD- o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE — 7/ 0 z -� <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS �33 3 ` �.ti GAO C.Ci�/^VCG <br /> S, a® r3& <br /> LEGAL DESCRIPTION(see tax receipt) CS/y vis I'"!� <br /> 300 <br /> DWELLING/BUILDING JQI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ co <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> W4 �cj <br /> STRUCTURE/ADDITION USE: -Q2W d7 cz <br /> O <br /> (Home/Cabin;Commercial Busines , Bedroom, Deck;etc.) m <br /> a � O <br /> BUILDING CONTRACTOR: <br /> CD � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81k X 11 SHEET OF PAPER. ANY INCOMPLETE OR T g W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> y l^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) In O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). U) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO3 w <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. t7 \ w p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO .Z Q) ^� <br /> BUILDINGS,ROADS, LAKE, LOT LINES. t G <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. pC 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. <br /> a n o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE RIFIC" CAA B6L �"HENSb <br /> ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 20Zo <br /> `) rr_' <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF Pt`f CC T\. <br /> ISSUANCE. IDNItNG �. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (5 <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 ARE �r /J� <br /> 5. 14,l 0y�{`//OILu t5\ y,(�A'In�/LC.t//trl /✓+✓� w cDi m� n F m <br /> 6. <br /> CD <br /> Z moo : <br /> 7. p r' m <br /> declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize l^ m o O <br /> CD <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ( m ` <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r : m o <br /> m m i <br /> 3 m <br /> SIGN HERE / a <br /> C ' <br /> Q J i <br /> (sig lure of owner or building cont /tor) (date) 1' <br /> ZONING ADMINISTRATOR ` OJTC' <br /> '.q'W <br /> Y)FA fA EA- N <br /> f✓� r') O N lNT O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />