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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 /> w t*si 736 -/o 0 7 y <br /> A ,yam '/ E// y�o-yz3r� n <br /> OWNER �lG/1,/TCL 47RT�-Y �b17/Uf� TELEPFIONZ 71,9—.Zs9- 7rd� ^C <br /> MAILING ADDRESS dal /V 0� 70h i u` <br /> m <br /> 0 <br /> / o LO1UC [moi' E Rd � �� �/ S Pa <br /> PROPERTY ADDRESS 7 � _ <br /> LEGAL DESCRIPTION(see tax receipt) Q <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION o <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNLIT q❑ SUBDIVISION ❑ f , <br /> STRUCTURE/ADDITIONUSE: 6E� /�/ d <br /> � X <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 31 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> As <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFI o <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. N C> <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONT TOR,ETC.,THE PLANS �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. C/ / J '0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT ATIOiE? <br /> '"41' <br /> I(/��' HEN <br /> NEEDED. <br /> �� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. '�a ` _ \i o <br /> CONDITIONS OF PERMIT: q®� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT` C C <br /> ISSUANCE. <�A' o� r 7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE'Y�N(� <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 Q� <br /> SETBACK AREA. <br /> 5. 5 v Sn (5C/W �e � CD <br /> :0 n r-D v D Oo M <br /> VWWGC&J /0111 36>-) c � �A,/ aax °6. CD 3 y <br /> � CD <br /> y N y fO <br /> 7. �^ m TIS : rn <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m — D <br /> PP ( 9 Y ) Y y 'O c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of wC E» <br /> .— c v 21 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize co e me <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 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to t hove described premises at any reasonable time for the purpose of inspection. T m o <br /> !! S fJ m m <br /> SIGN HERE <br /> () nature ofor bulkillng contract ) (da e) ` 0' <br /> ZONING ADMINISTRATOR /7) <br /> `- <br /> O fN Nf W 69 N <br /> N <br /> (l� 0U� U100 <br /> 1 <br /> 3p-(�l� TOWNSHIP PERMITS MAY BE REQUIRED 701'7q �L ^� <br /> Q U)7V- ` YTHIS PER(NIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />