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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator TI o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 (� <br /> N � <br /> y <br /> c <br /> TELEPHONE q <br /> OWNER (GI,S 44� Sta ^✓ ��SL G��6�/ 7 //7 I <br /> MAILINGADDRESS OSS S J�p�nJSO� ,Vlc� ��`�STF�L W I �7'� r✓ v O <br /> o <br /> PROPERTYADDRESS I✓t �' <br /> LEGAL DESCRIPTION(see tax receipt) rl-.L l.T 00 LOIS S <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION y O <br /> TYPE OF PERMIT(S): it <br /> FILLING/GRAADCDING ❑;7 CAMPING UNIT El SUBDIVISION El / <br /> STRUCTURE/ADDITION USE: JU d &oafs OA) eX I S ) ) d& �(iC IL 0 <br /> ��'' <br /> (Home/Cabin; Commercial B'usines% Bedroom; Deck; etc.) tj <br /> rn � <br /> BUILDING CONTRACTOR: eG�2 - Ge <br /> o a i& o eJS j rw•GI�O� ��F/�� ( <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BX X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> See (/anu^.c yyy o - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -r f c���( val/�� O a <br /> r U J r Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m j� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). in <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)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 /> 17�- <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 0 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> O � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 4 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o r ,- <br /> CONDITIONS OF PERMIT: �1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. C) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. <br /> W : 0 M 0 ODa * 9 <br /> 6. m x.a n m x a T. ;a <br /> a o <br /> Z mcNo . .S3 <br /> T cinm1 <br /> o m T A <br /> = v I m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize J[ m c ! <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 Burnerelying on this information I am ^^ '' � d <br /> providing in this appl' ion. I agr permit county officials charged with administering county ordinances or other W ' @ m <br /> authorized person t e acces to the bo described premises at any reasonable time for the purpose of inspection. <br /> T <br /> r m Di <br /> SIGN HERE <br /> (si re of owns or building contractor) (date) o <br /> ZONING ADMINISTRATOR (� <br /> (J O N O N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FRO DATE OF ISSUANCE <br /> WmT+-+- Le,4'+e WZil��t, ngs-ffarn 0-bA -hr -(-- -ion 616 6 <br />