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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 3 <br /> r <br /> y O <br /> OWNER TELEPHONE �j4 66'9- 91` �Gam <br /> MAILINGADDRESS ��-7 �� C �� /,� �jrv�c y/>✓//J �S`Z��� O <br /> r � <br /> PROPERTY ADDRESS L� �� Gi�/F� C� �J [��` �,{J /VZ o <br /> LEGAL DESCRIPTION(see tax receipt) <br /> o ;� f4-CRs Loc %o %Zoe-iyw`'S' �j <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I ADDITION ❑ (n o <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑y SU DIVISION ❑ n 00 y <br /> STRUCTURE/ADDITION USE: .STo <br /> - <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn f <br /> m <br /> BUILDING CONTRACTOR: 'p- <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T _ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m 1 p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 01 o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. P <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. IN <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. o <br /> o � I <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> P <br /> CONDITIONS OF PERMIT: <br /> I C!� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (r^_ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> bhl <br /> SETBACK <br /> s. f , ZS—Co-,l a.So <br /> dem al ejaco Slrc <br /> nGL - bf �e( �r riVa4e "-S <br /> be usrahuman hab`fh�in• <br /> X CD0d > 0a ° m <br /> A <br /> 6. J Om O GT. <br /> F3 nm �c ... _ 3 <br /> 0 N C y 0 <br /> Z C in � 0,,O <br /> 7. O t m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - ^� ' <br /> PP ( 9 Y I Y Y E G) J . C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n <^ <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize m c I o <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. I further accept all liability which may be a result of the County of Burnett rel in on this infor ation I am m o <br /> providing in this application. I agree to permit county officials charged tyith e r otherUT I <br /> authorized person to have <br /> access to the above described premises at any r I po- ction. T n <br /> SIGN HERE <br /> (Si nat/urr sof o r or building contractor) HP 8 ate) 0 <br /> ZONING ADMINISTRATOR \ �I r d I Q n(oa J , 1 <br /> BV N O n N N iA W W N O <br /> TOWNSHIP PERMITS MAYBE REQUIRED ZONING o u o u v u o <br /> THIS PERMIT TALL EXPIRE ONE YEAR FROM DATE OF ISS E <br /> NC <br /> m� ( -lei malted tirn yBrande� � <br />