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CD <br /> Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 3 04?- <br /> m � <br /> A Q, f p/ / n <br /> OWNER�m C AVNTELEPHONE l��O[� 1p -707 <br /> w <br /> O <br /> `` <br /> MAILING ADD0?83 7 / I�P�SS QJA Itkn f , (11� <br /> �i-ESS �K � rl� r � 1 <br /> o \ <br /> PROPERTY ADDRESS <br /> U S YYl <br /> O 0 <br /> LEGAL DESCRIPTION(see tax receipt)�oLt S c a y Naim 0 <br /> N <br /> °� 0 <br /> DWELLING/BUILDING,7—'7 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ y n , <br /> / <br /> STRUCTURE/ADDITIONQSE: HG`1✓I J j1,4(H me/Cabin;Commercial Business, Bedroom, Deck,etc.) <br /> BUILDING CONTRACTOR: j06,1 42 i <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. (j ft71 ����� 011 0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) � To Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m c <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(8)BUILDING(S)TO Z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 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 r <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 C �, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAr <br /> NEEDED. _ 4� <br /> G_ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 'SPR 9 6 ° <br /> !` 1 <br /> ONDITIQpg5 OF PERMIT: QQ//� 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERIul1YR V rr CC <br /> ISSUANCE. / <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ®IdIryG <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. <br /> CD 3rn <br /> Cc, on � <br /> 9 y N <br /> 6. � ym0 �<c <br /> Z <br /> '!'2 <br /> 7. _� i M <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my F c C <br /> CD <br /> o f <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C ul <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other D N <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. -n ; 0 : <br /> hrl�slO w w <br /> cn C . <br /> SIGN HERE (data) <br /> CL <br /> (signature of owner or u ding contractor) <br /> o <br /> s a <br /> ZONING ADMINISTRATORG N N N N O O <br /> / O �nornu+ oo <br /> �pQ l (/-G TOWNSHIP PERMITS MAY BE REQUIRED �(Q� 63k, — o,� SQA ja,y <br /> 0 THIS ERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �� <br />