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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator _U G) z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> O <br /> /3 <br /> / C� N <br /> OWNER 13 F T/7 A z/ �C��— D � TELEPHONES_I <br /> MAILINGADDRESS 'fes 19-r3)e /117yL�/��f S��rl�' 16/i <br /> r m <br /> PROPERTYADDRESS Z —7 Q 'T'nnA"Ls g 09�7-:e � � <br /> � ��'� S j.C-A Xl o <br /> S `l , i�'/� /V/ ✓cry r U G c L/L % 2— <br /> LEGAL <br /> LEGAL DESCRIPTION(see tax receipt) Sic 3 3 7�lj/o - I t t,/ _7&1%0^KJhkP <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION Cl) <br /> TYPE OF PERMIT(S): a ' <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 5. <br /> STRUCTURE/ADDITION USE y�/L L S J�� �NcLi �iA/Z �YS%L'ck/ 0 <br /> (Home/Cabin; Comm rclal Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: ���13Ei(G <br /> � m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m O <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). (n (� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFZ <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. 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. f <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S, <br /> NEEDED. /��� 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: p�1, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT JUN 1 7 R� 1 <br /> ISSUANCE. 2OO <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY BURN ETTCOON PERMITTED. ZONING <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER G <br /> SETBACK AREA. <br /> 5. � <br /> /i, n/ <br /> /L(7)1I1� m omni ro mxvavv <br /> n � <br /> 6. 3 nm <br /> O 0 co y O 3 <br /> 7. N to O <br /> O j, G it <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my LU 3 ,-C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 : iA <br /> Pp (including Yaccompanying ) g <br /> all information contained in this application includin an schedule and I further declare that I reco nize m o m <br /> that this information 1 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 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 the above described premises at any reasonable time for the purpose of inspection. m o <br /> �/f7— <br /> Is <br /> m m <br /> SIGN HERE JFisi G Vivi 7 c d Z "' m <br /> a : <br /> (signs r/ owner or building contractor) (dale) <br /> ZONING ADMINISTRATOR I rYl i IdYII/I . <br /> M M <br /> rrr��� M MEAN)0 N <br /> N N N N O O <br /> rvJ,(TO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />