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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 /> S v-e,✓ dy` TELEPHONE(6143 0 o fol n -c <br /> OWNER Jv r p a <br /> w ry <br /> MAILING ADDRESS 26)4 // (04-h �54-, /w SSDO ) <br /> ° <br /> PROPERTY ADDRESS -27)90y et t-L �+` r Q" '/ � <br /> I t <br /> LEGAL DESCRIPTION(see tax receipt) C L rle- l m <br /> �,r <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION pC�te—Ilo y ° <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ UBDIVISION ❑ ton <br /> /' II^ �C�/,,/[�y 0 <br /> STRUCTURE/ADDITION USE: �rJ If, U7'I'7 h 11(-f K �<�j—gLr�E <br /> `p Q <br /> (Home/Cabin;Commercial Business; Bedroom;'Deck;- tc.) 01 X 3J ( <br /> 2. <br /> BUILDING CONTRACTOR: �` ��� �` SeV � l,l.���'' ' 7 <br /> 'D <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> m <br /> ?f o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 w j3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C m <br /> NORTH(N). rn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF t o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED O ( 0h <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRPLANS S2. l� <br /> MUST BE SIGNED AND DATED BY THE OWNER. ]� ° 6� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN 1, 1 .l � v <br /> NEEDED. - Lf <br /> 4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. JQN 1 AA <br /> B(f 9 / z " 1 <br /> / o $z <br /> CONDITIONS OF PERMIT: �{ p 7 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 6t PAI&7 E �!� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SIIl7E.N� �y 'Y7)- <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER, <br /> 5.�ISf7 n AREA <br /> Wall l l C a'yey -/-b -12-eL7 <br /> �} U l�tvr� nS . �1 - Alc "� ✓e t, ui�ll o� DODov <br /> s CD <br /> f m <br /> 1$ C( ��Uf ClPt m CD C m 0 d <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - �' O <br /> PP ( 9 Y ) Y Y : �t : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m, o m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ()J <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> CD '• G <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 E 1 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> P 9 � PP 9 P tY 9 9 tY <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of inspection. mo <br /> SIGN HERE <br /> (s gnature o" f owner or bulIP9 contractor) (date) <br /> ZONING ADMINISTRATOR <br /> EA(A fA fA 0 N <br /> Se �'S/Ty��0—W IOU (CA0LnnM00 <br /> ` TOWNSHIP PERMITS MAY BE REQUIRED <br /> HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />