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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> owNER 'Y LGr� <br /> _A, F T o Lev- TELEPHONE �'�' CCDZ- SG-10 v <br /> ' p _ m O <br /> MAILING ADDRESS IV �Q©�� 11��� Si P('eSCGA Uir 54OZ1 � <br /> r � <br /> o <br /> PROPERTYADDRESS ' l"103 Mu Kf-ir., LaSe- �J- Styr*,. <br /> t <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) C S j�.� J q p,3,-�)_ 33 C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑IA'� *37a,5- ° <br /> TYPE OF PERMIT(S): c <br /> c <br /> FILLING/GRADING ❑ CAMElt.&6,;j PING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: 6 Ve-*,— U .-3 x a 9 ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m r� <br /> BUILDING CONTRACTOR: <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p —��� <br /> ;6NW <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO) <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 ,U1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 0000 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS ppI,, <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE-IEN 1 ° <br /> NEEDED. �-^ <br /> 'l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. rt�gR 2 n o <br /> CONDITIONS OF PERMIT: Qup�1 J 2OOJ \ (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFISSUANCE. PERI(�11����� J <br /> Z REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELW'E I Co <br /> Q� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �I N <br /> PERMITTED. V1l J <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER L` <br /> SETBACK AREA. -A <br /> .7� Gly L2C��� �``z1 �c1 'Y�i ��act Sa�'`e' <br /> �/n� m mdcDimn � m <br /> 6. 44 7•`(l� r 3 n m x a � M <br /> m C N y O j 3 <br /> 7. a N O = O <br /> O T �1 <br /> cn <br /> m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v v. <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o ? m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D <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 <br /> providing in this applicatio I as to fermi my officials charged with administering county ordinances or other <br /> authorized person t have to the abov cribed premises at any reasonable time for the purpose of inspection. o : <br /> 2 �t m m <br /> CD <br /> SIGN HERE 3 Z S p��3 <br /> n : <br /> (signature of ownera-, <br /> contractor) (date) <br /> ZONING ADMINISTRATOR zin <br /> fA fA EA f 0 N <br /> NCT NNOO <br /> Va- <br /> AO"TOWNSHIP PERMITS MAY BE REQUIRED7 <br />