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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 . <br /> r90 <br /> ac <br /> y <br /> / ` C <br /> OWNER j�a�K zJ (J i<irG� �J 1 �. TELEPHONE 7/SCI)t <br /> MAILING ADDRESS 36 / FALL w, o <br /> f <br /> PROPERTY ADDRESS 124,9A- C•t Y\I^tiil/v, C--c1 <br /> I-at A4 1 C'5 M Vol / Pat-)C /C/iiS �;�)) P�t'Ce� I rM AGI�G�i ft l/ �t-y71t11 <br /> LEGAL DE9CRIPTKNU(see tax receipt) (r."t"�V`� f�O� 4- 2 —31� 1 / Cl) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S�U�BDIIVVISII,ON/❑ a <br /> STRUCTURE/ADDITIONUSE: S. <br /> b�Ci� �S�\" '"`tit t/', � ��V �� La. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn ob <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w t-v4Z,�' jZp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M O <br /> NORTH(N). <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. o <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. �Gf. o <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,CONT ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC ION MA DOO <br /> NEEDED. p n , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. #4 w o F�� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT2O. /N Fr CO <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G s11 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. � _- ( n <br /> 5. Port_ `� c72 C � i��ta�Y-d /101� A+,eF, --V <br /> 6. /Nee-f- /✓)flk ufe L /�f' u� m nO m cDi m o f m <br /> m C <br /> 7. z in � O <br /> p -n 3l <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m CD : M <br /> PP ( 9 Y ) Y Y O� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeC c ; t m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �r�f� C <br /> W ? ): i <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 ro ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m Ln <br /> m o <br /> CD <br /> SIGN HERE �� -0/0SD <br /> ( gn ure of owns or buildind contractor) (date) a <br /> ZONING ADMINISTRATOR ) E E <br /> uNne o o <br /> rix 0', S��slu TOWNSHIP PERMITS MAY BE REQUIRED ((��� L(( l a g w� <br /> 6 J.zi THI PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />