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R� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o- C o <br /> CID APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER 7WO 1W a S O /(/j1/v G � �g� ,DG� TELEPHONE 7/5-pZ O jZ -S _?7 O VJ <br /> /l m � <br /> m <br /> MAILING ADDRESS �p(�LJ/� R t'�/`�SC p� w/� �y0 v O <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) N� s _ Se a 5'- U) <br /> CID <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 161 "/ (n <br /> o` (/I <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING U��i}'{T ElSUBDIVISION ElS. <br /> T.n <br /> STRUCTURE/ADDITION USE: _&A rc e-.vr �/7/C�/T �� ° I p <br /> /�W� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc..)) (n <br /> J <br /> BUILDING CONTRACTOR: /7 4/Cn �" C[�'J!r a CrGO/(/ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> ;0 <br /> A m � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n W <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). U) o <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. 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. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N QI <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. F I <br /> o � <br /> NOTE: BUILDING/STRUCTURE 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. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` `� (1 <br /> ISSUANCE. (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W : <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER J <br /> SETBACK AREA. <br /> 5. <br /> X co0r- DODO -0 <br /> m c m 0 m n f m <br /> 6. 3am � am .� <br /> omcN � o � 3 <br /> Z c in o -i <br /> 7. o 21 m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - A <br /> PP ( 9 Y ) Y Y G) � C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of u <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (n <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 I m o <br /> providing in this application. I agree to permit county officials charged with adminis �— <br /> authorized person to have access to the above described pre ises at any reasonable ' t e i m 'a <br /> T <br /> 7- VN <br /> > : <br /> SIGN HERE a <br /> (sign f ow er uilding contractor) ��� �dfe)2,, <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY l� g Cn o Nril r� g <br /> yOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />