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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator v M z <br /> PLICATION FOR LAND USE PERMIT$ �. ° <br /> �11 (C � (I � ri� � SNL � CleitieEiu ,�� r c C>-3 <br /> CD <br /> OWNER r� (~ �15' 1 I 1cE ! 2;219' <br /> o \ `l <br /> m <br /> MAILING ADDRESS f�(� (� O N <br /> o m <br /> PROPERTY ADDRESS f a u�q 2 t )L <br /> LEGAL DESCRIPTION(see tax receipt) Z e 5;/111 ��L 2 y /g y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Q ', <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ C MPING UNIT ❑ SUBDIVISION ❑ CL <br /> - <br /> �Z <br /> STRUCTURE/ADDITION USE: <br /> ��Sfak a", o <br /> (Home a i ,Commercial Business; Bedroom; Deck;etc.) co <br /> BUILDING CONTRACTOR: L / �` f? ^�I tz' J 11/ L 3 1�j <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. I O ,. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> 0 o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> I n m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB) NO INDICATE m m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINO(S)TO m 66 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(O WM)OF C Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. (J� o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. i <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETCi,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DNE WHEN o <br /> NEEDED. �• <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, o I <br /> CONDITIONS OF PERMIT: lJ, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. l� h <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 11 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED <br /> TBACK AREA. <br /> 5. <br /> 6. 1'La w ��C) 'pLV` V�!Wl� — I I m <br /> ��r i rX S��/ ( C-1 —V 6� m B a nt a m <br /> v <br /> 7. Z N NO O C ow <br /> y 7 fp <br /> O TK M <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and tot a best of my G) O <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail ani I accuracy of (((vy, @ r0, ' C <br /> all information contained in this application(including any accompanying schedule)and I further declare th t I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining i whether to is- m:U <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 agr to abpermit county officials charged with administering county ordinances or other v <br /> authorized person to have ac s t the ove described premises at any reasonable time for the purpose of inspection. <br /> m o <br /> SIGN HERE <br /> (signature o owner or building eo rra^cto�rr)) ; (date) a <br /> ZONING ADMINISTRATOR C`A `L✓ N !L� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> C, (n 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ) <br />