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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> n O <br /> y <br /> V C Q <br /> OWNER ��y� t° G /�.� TELEPHONE (e - I 3 0 Xj <br /> `Ios1 �JZ S`1 � 93 <br /> MAILING ADDRESS Y @pr r1oQ, W e�S�eh i <br /> rCD <br /> PROPERTYADDRESS <br /> �'/,�, I�.p�/ <br /> LEGAL DESCRIPTION(see tax receipt) L q ala;-� Q-F- '& 1 Q�f I e aA", m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® Cn <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑p PICAMPING UNIT ❑ SUBDIVISIONOF <br /> ❑ <br /> STRUCTURE/ADDITION USE:-sed f)� � t �- t6 " 4161-Ce41 sL l tV uEL <br /> Horpre//C in;Commercial Busi ss; Bedroom; Deck; etc.) d <br /> 2. <br /> BUILDING CONTRACTOR: S �kX1^( T�✓- <br /> CD <br /> � l <br /> C <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 17 SHEET OF PAPER. ANY INCOMPLETE OR In '3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> �t 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 <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> 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. 1 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. (� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS is- 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. `� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC�1 ONE WHEN S o V) <br /> NEEDED. f 's-' "»CCC ) <br /> Ct <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. =J <br /> 1 <br /> CONDITIONS OF PERMIT: MAY (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P�RMIT ZO� z: C <br /> ISSUANCE. UEVN <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE.' I I (�'O a , CJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZQ(yING LINTY C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE <br /> /REQUIRED WATER <br /> SETBACK AREA. <br /> 5.�pytc <br /> V7 r-'? a m w ori 0m� a i m <br /> 6.(L.I t6 / O�['' i m 3 aim x ° m <br /> m C y y O j C <br /> Z W O O 0 <br /> 7. O T� 3) <br /> =rni E <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c 5 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of iu 0 : v, <br /> �: a cn : F5 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- i <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am w <br /> providing in this app li n. I ag► a to permit county officials charged with administering county ordinances or other o <br /> CD : rn i <br /> authorized pe on to v acc s the above described premises at any reasonable time for the purpose of inspection. - o <br /> m <br /> SIGN HERE Z 7 d' o. <br /> (sidoature of owner building contractor)- (date <br /> ZONING ADMINISTRATORI/� <br /> fo VVW� TOWNSHIP PERMITS MAY BE REQUIRED C <br /> C314 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />