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Burnett County 7410 Co. Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> Z o <br /> y� �//�� f a39 %�9s r se a <br /> OWNER l,C 4 e ne !/ • tl V0.Y I.0 ng Cto-SC'_ TELEPHONE 7/S, yC6 - Y� �7 a <br /> a87/ 8 ,"r)e yan r / L3/a�n;D S�pr,dys 354/3- <br /> MAILING ADDRESS CD <br /> 7�y[6 �' , tJe o" S �G ctK/� /1CJaotC� 1 WQbSftr hll� 5893 0 <br /> PROPERTY ADDRESS 71 Y(v y �z� 1 IS ^ 0.^e k IVA v, w I ,57 173 1 t 1 <br /> LEGAL DESCRIPTION(see tax receipt) ,- 3s/u1 `/ :?6 33.-,{Q z/( � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION rn <br /> TYPE OFPERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ f <br /> // ii� L1 _ i i 1 0� )or r�',ef.'cYn l y <br /> STRUCTURE/ADDITIONQSE: '/;I- D 0.1 h — u Ad t ri o nam 6 e-d r o 0 m S.oac a N�' Nie• - 9 r <br /> (Home/Cabin; Commercial Business; Bedroo ; Deck; etc.) m <br /> BUILDING CONTRACTOR: �GT <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/4 X 11 SHEET OF PAPER. ANY INCOMPLETE OR In _ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> OD H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> Tf � <br /> v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn v <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C5 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS w 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m <br /> v � � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> QJ <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <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 ^ I <br /> �1 rJ� SG7bAG� fi ue _3Q <br /> Lt �" PG//11{ i►' m• mm r>y 0 a fm <br /> mny ;n rJ3&I c mm <br /> C <br /> O j <br /> S�tbA�k aim. rn,t� �� n>��- ��/t�,► ; T o y m0 <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m o i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> - CL$ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is CD3 <br /> O: : <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o ; <br /> m rn i <br /> authorized pe on to have access to the above described pre i e fo tha purpose of inspection. c , <br /> SIGN HERE CL <br /> d' <br /> is na ure of own r o building c ctor) (date) E <br /> JUL 2 7 200 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS M <br /> j <br /> N o l� 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FRSOF ISSUANCE(J _ v I Lq Y) <br />