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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> OWNERDave Ce �l em Ate e ]rl Y TELEPHONE GS I-ZYM ! q 3/ O -X) <br /> MAILING ADDRESS 10iyiy 6 5 f Al Gfo/i f i'ecv i sllpT�W 5S0 Xa <br /> n_ /'/ \ r m <br /> PROPERTY ADDRESS aqylA I.�Jhlf *r i•�a l�l r1CS ��J ` I X�/I Iry Ws SfCb o w o <br /> r C� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> west I cn <br /> H SeJwn(or�let'' &{,d^t I-yp /�-,Burne LJ� 0 F <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE W ADDITION <br /> c n <br /> TYPE OF PERMIT(S): � y_ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION' �'❑,a °' <br /> STRUCTURE/ADDITION USE: , S ^4 ��1` � <br /> _ // (Home/Cabi Commercial Business;Bedroom; Deck,etc.) rn <br /> BUILDING CONTRACTOR: /CC C.QASh-udioet d <br /> CD ti► <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> it N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ^� <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO p <br /> BUILDINGS, ROADS, LAKE, LOT LINES. Y <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 11N Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS a <br /> MUST BE SIGNED AND DATED BY THE OWNER. -" A <br /> v � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC `O,NE WHEN o <br /> NEEDED. UU �1 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � o Q <br /> CONDITIONS OF PERMIT Dc^ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P C4 J <br /> ISSUANCE. "�/VE1 pV <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. PE GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 2O)V,Cl/�/1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> /S�E,�TBBACK AREA. `/ ! � / „ Tim U 7i <br /> 5. WY td4�p�� j� 7 L1 a t_ /y G f Z( l/1l/�r/ ((JZ Q� lJ� /� <br /> 6A <br /> �'�2 `J / .."� L1(J„n S. Dot. /' ,1 /cx.m(.(�.�. 0 m o � a m <br /> n r LD. 3 n m a <br /> 7 C/ / • "'i _ �.G.IfJK_/ r lJL I V /C. (^I'��'<c�" _ r' �.(� W ` — v Z N C y <br /> P T K m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of @ in e <br /> a : <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m (D0 o mM <br /> o <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. 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. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have acces%4p the aboo described premises at any reasonable time for the purpose of inspection. m <br /> -n o : <br /> m <br /> fZ— <br /> SIGN HERE / <br /> u of own uilding contractor) (date) <br /> ZONING ADMINIST ATOR <br /> 1_1\ EA fA EA V N <br /> to Ocn 00 <br /> TOWNSHIP 4RMITS MAY BE REQUIRED <br />