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onS( �o N ud Late_ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v C) Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> r <br /> rn o <br /> N <br /> OWNER <br /> 7e-(-(- y' /<c.c\ St✓ TELEPHONE �- (0,5'/ -PCjp 94CIs <br /> � .�) a <br /> O <br /> ^ ` I �( ro <br /> MAILINGADDRESS � Sn1At\ ✓ /^�y,� 5/' Po,UI /314) SSle) 0 <br /> ,7� <br /> PROPERTYADDRESS 6-f 94, KJ2V �S Ly Ce q,393 0_ <br /> / <br /> LEGAL DESCRIPTION(see tax receipt) SPc/tr`on 4l O Q, 6 Cf/r/ V <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION p� o <br /> TYPE OF PERMIT(S): rn M ?�'( <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n 1 <br /> ffII ft1 1 1 1 <br /> STRUCTURE/ADDITION USE: 1'�00� Y. 01 J,co, Re-roe, AQ)d (cuetffd P-Jij o <br /> ((�J {// (Home/Cabs , Commercial Business; Bedroom;Dec; etc.) 93 3 <br /> Ce/ En <br /> BUILDING CONTRACTOR: Up(f / [fj./ cpH k-"-C-� $j36 7/5--b- 1*290 M, y <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O <br /> n a A <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. p Z A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m p p r <br /> NORTH(N). C Y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO frit 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFIT <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. (\\ 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS v 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. g • <br /> W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN t <br /> NEEDED. w <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> i <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. oQ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ^C <br /> PERMITTED. pQ L+j <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. <br /> 6. 4) c m m 0 Mo a o m <br /> fm <br /> m 33 nm x ?mA <br /> p MCN '^ o � _3 <br /> 7. Z N 7 ID <br /> N 7n [ E Z1 <br /> I declare that this application (including any accompanying schedule) has been axe <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsmined by me and to the best of my - O1 D <br /> C <br /> ible for the detail and accuracy of <br /> all information contained in this application(Including any accompanying schedule)and 1 further declare that I recognize m $ -ether to is- <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wh `� �n M <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. 1 agree to permit county officials charged with administering county ordinances or other <br /> 'm m : <br /> authorized person to have access to the above described premiseas at any reasonabl It pqr-to m <br /> l a : <br /> D <br /> SIGN HERE _ rJ Ch " t6 $ <br /> ( natu owner or building contractor) (date) o <br /> ZONING A&INISTRATOR <br /> APR 26M <br /> � ISSIJ SCrf[nPc;ch s 1-1 <br /> S-l3' 17 on«uHw�a Jo <br /> 1301 a 6arteye TOWNSHIP PERMITS MAYBE REQUIRED BURNETT COUNTY O u O N N u o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAKOIQIING <br />