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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 3 c <br /> -ui-950--nwi y �_ <br /> *kj,..JIV39 OnTi/ <br /> OWNER STP✓VU /��f[/nLST+ti TELEPHONE /56-3090 TG[ r/D�F7-OG 0 <br /> �T— fO _ <br /> / � O <br /> MAILINGADDRESS 60✓ � Dinucc Ellin kit 5'/'P.3 in <br /> � r <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 46T 12 ( SYm V 17 P Z53 \ <br /> �l�77I31 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Iql (n o <br /> TYPE OF PERMIT(S): ZN <br /> /'Dol O✓Gr eas-f <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION OIL- <br /> 1 <br /> N <br /> STRUCTUREIADDITIONUSE: L11 /h4 l7nn t Two �i'X )� [� 177,0O 7D ll q, <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: n- ,L)II cn n C? <br /> m � � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y vi <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m (T 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF n <br /> ° <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. Q> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS -�D 0 \ <br /> MUST BE SIGNED AND DATED BY THE OWNER. GQ,o o <br /> o I_ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. = r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o '.0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J ,\ <br /> ISSUANCE. Uj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X a m d 0 ° n £ m <br /> 6. N F 3 6 N 0 ¢ � -it1 <br /> v pm Cy .`" o � 3 <br /> 7. Z c m o <br /> o m rte : <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m E^ O <br /> PP ( 9 Y ) Y Y C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- s <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 : o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person t ave access the ab scribed premises at any reasonable time for the purpose of inspection. `D a <br /> M <br /> � <br /> SIGN HERE-0 <br /> (si"g�nat�ure of owner building contractor) (date) <br /> ZONING ADMINISTRATOR \_ll � r �Qn L I1 ((I� <br /> v�fAMfA EA�N <br /> ^O N U W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE nP ICSttANCE <br /> ,Perri-)N-d-le--ea pic7w' op " s�rryyol, o� '7-d6 <br /> T?I�' <br />