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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS <br /> SC1i'v <br /> OWNER ( l U d <br /> MAILING ADDRESS BILI G>e?k %Jrl Vt° Zc-4//�,4 �n_ �SCIZ V CD <br /> f O <br /> PROPERTY ADDRESS 1�L+/yl C7 <br /> Sic c2�� 3G Ccrus , clv, P_�tS � 'L 661v SZ) 'q <br /> LEGAL DESCRIPTION(see tax receipt)�_C 6 ` �Y <br /> DWELLING/BUILDING ,®--GARAGE/AC ESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): y o <br /> C � <br /> FILLING/GRADING ❑/ CAMPING UNI ❑ SUBDIVISION ❑ a I 1 <br /> STRUCTUREIADDITION USE: 4 l 4e- N: <br /> Home/C bin;Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: 1 1 l -`'e 5 , 1 �Yt W r <br /> 42 <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. 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) (� <br /> 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <br /> A m -I� Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). n <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)OFU v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. -�r Z <br /> 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. Su <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS p 0 �J <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o ppp� <br /> NEEDED. y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. °Q <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 <br /> 1p..AREA. <br /> 5. 6� / -41-6 :3 <br /> 4 -6 J . C(,OY •(1 '/��7J�( — Cl`tl. CS 41e <br /> 6. <br /> CD yy�vDaO � <br /> 7. m C N O j <br /> Z y 0 0 7 M <br /> T" <br /> M <br /> I declare that this application (including any accompanying schedule)has been examined by me And to the best of y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy mof d, S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize a <br /> C o : rn <br /> v m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m E <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 m <br /> providing in this application. 1 agree to permit county officials charg Irn <br /> authorized perso to have access to the bove described remises at �fnance"s or other m <br /> P a o o _ of inspection. ° m m : <br /> T <br /> SIGN HERE C L CC lE" C 1� - m m <br /> d <br /> (sign r of caner or twlld ontractor) OCT 3 2W3 ( t '. n <br /> n * <br /> V r <br /> ZONING ADMINISTRATOR /Y1 t2h <br /> BURNETT COUNTY ' <br /> royrr) " N <br /> TOWNSHIP PERMITS MAY BE REQUIRFWNING o`O o' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE , <br /> fI0)-013$3 <br />