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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator _ o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> N <br /> OWNER G S T z TELEPHONE <br /> MAILING ADDRESS 3 �'z LZ OV/�) SeUs Ile- 1-17<1, 5-5//:5O <br /> CD <br /> PROPERTY ADDRESS � lr ji �� S S r//e17 ev. ` 57'(f/ 2 L o/ 3 C K7 0 <br /> l <br /> LEGAL DESCRIPTION(see tax receipt) ` �, 13 5�7 GS, ( �rO 3p I 63 m <br /> CD <br /> DWELLING/BUILDING LJ GARAGE/ACCESSORY STRUCTURE LTJ ADDITION ❑ - CA <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRAD NG El `CAMPING UNIT 1:1 SUBDIVISION ❑ C <br /> STRUCTURE/ADDITION USE: Ll �l-o' `� �iGr"b�'��' <br /> / ' <br /> (Home/ Commercial Bu/siness; Bedroom; Deck; etc.) w <br /> BUILDING CONTRACTOR: G✓CrS/1r e- <br /> :` <br /> Z <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p fit <br /> � w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). yZso <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mB <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 /> S. 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 090 <br /> MUST BE SIGNED AND DATED BY THE OWNER. l a <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o V-1) <br /> CONDITIONS OF PERMIT: <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. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY y <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> �s ���I�l°d� m S w o m a <br /> uGf m <br /> 6. 3 nm Fnm <br /> O m C <br /> 7. Z y 'WD <br /> P 41� . m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — �' 0 <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a ; N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m W o O <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. 1 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 o <br /> Cn <br /> authorized person to have access to h above described premises at any reasonable time for the purpose of Inspection. m o <br /> CD <br /> SIGN HERE '/ /✓ Q / d' E E ': <br /> (signature Towner or building contractor) (date) <br /> ZONING ADMINISTRATORy 1 <br /> N VIN ro N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED NON V O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />