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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N 0 <br /> 4l <br /> (]� C r <br /> / N ^� <br /> /Jr n <br /> OWNER ZY114 �ct i �11 T TELEPHONE 7! ^ 8`46- sob <br /> 1 ' lLfp(� m O <br /> MAILING ADDRESS 7560 LA�tDO h �,1, � 1,,/e bsfpr 1/ I J 10l_� CDo <br /> PROPERTY ADDRESS S Q W <br /> 61��1t 9j <br /> LEGAL DESCRIPTION(see tax receipt) G j C 61 el 104t/ CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY ST CT RE ❑ ADDITION ❑ c <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ lad/ �(� < <br /> STRUCTURE/ADDITION USE: c� r r ra 0 NUJ Sty Q01-3 a c�nd //7P`(` X7 p <br /> Ho a/Cabin;Commercial Business; Bedroom; peck;etc.) m ) I% <br /> N'o+�-penm, abv3 f , Pta)pa4exx 3, tu <br /> BUILDING CONTRACTOR: 42 <br /> , <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) o <br /> n m O <br /> �I o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). ` 3 <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)OF Z <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 I I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS -Z ��f -4 <br /> MUST BE SIGNED AND DATED BY THE OWNER. -Z F <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 9J <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (/y <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 AREA. _ �l his �1 <br /> 5. <br /> ���//v 70 C11 1 m 00i m RL O M <br /> 6. n 3 nm Fam <br /> m Cy N O j <br /> Z y iP O O tG <br /> 7. o -n' m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my G7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w CA <br /> a0 v . <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o <br /> that 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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am ro <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 0 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m m o <br /> 3- IcI _ O ,/ m m <br /> SIGN HERE y �' C <br /> CL <br /> (signs�eowner or building actor) (date) r : <br /> o <br /> ZONING ADMINISTRATOR <br /> �ya�o�� o <br /> 3_ y TOWNSHIP PERMITS MAY BE REQUIRED I S(P <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> le lki' czlsa aW3/�{- f►t(- d GRVA <br />