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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 OZ <br /> APPLICATION FOR LAND USE PERMITS 0 0 <br /> o <br /> N <br /> -715- 3.;)7- 9 817 n o0 <br /> OWNER I ' ��r TELEPHONE 05-1 � qq%i w a <br /> J / 0 v\ <br /> MAILING ADDRESS <br /> 1115CD <br /> �It1�Qa S7 cL�r Sf �[xLIL iMyt SSII{, <br /> CD <br /> o <br /> PROPERTY ADDRESS 1 ( Slo( I <br /> t'�r a cart—�-ecnhc, Luc/c <br /> LEGAL DESCRIPTION(see tax receipt) FIC is L --3-7— 1 <br /> O r <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION o <br /> TYPE OF PERMIT(S): • <br /> �Lim .5 1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ta <br /> N \t <br /> STRUCTURE/ADDITIONOSE: d P LIt � 7V <br /> C (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) to <br /> BUILDING CONTRACTOR: J P r c fir. C12 Sf <br /> Z � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> 1I w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p D <br /> CL <br /> *� o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ff m 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !? <br /> NORTH(N). <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ' <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. C'o 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. Q' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED ORD. N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONS C.,THE PLANS ) 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. / F <br /> o � R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC N MAY <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: &(% <br /> t <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZO ACO��AK/� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. 3 <br /> (D am x • m om <br /> 0 <br /> m C y O <br /> 7. Z <br /> O T G M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m E '• D <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 w <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize E m " <br /> PP ( 9 Y ) 9 (D M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- y <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 a E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized per on to have access to the above described premises at any reasonable time for the purpose of inspection. m ` o <br /> SIGN HERE (A ( — D ; <br /> is gnature of ow�34njcjp�q o building contractor) (date) nZONING ADMINISTRATOR \ I Jn <br /> v /? k i» <br /> to <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o <br /> 0 t THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />