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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 �. <br /> r <br /> CD <br /> // C <br /> OWNER <br /> `J� Q�o c t TELEPHONE 7/S - 6'3S- 7SG K v 0 <br /> CD- <br /> MAILING ADDRESS /_S G <br /> PROPERTY ADDRESS ��&$t 2. <br /> LEGAL DESCRIPTION(see tax receipt) N6 a <br /> ❑ GARAGE/ACCESSORY STRUCTURE ADDITIONctb PtLIQ "'"�1 `� <br /> DWELLING/BUILDING vi � <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADI ❑ CAMPING UNIT UBDIVISION ❑ /i�►1 j� / �_ <br /> STRUCTURE/ADDITION USE: /gin /.r r f` <br /> (Homee/Cabin;/Commercial Business;Bedroo , Deck; etc.) w <br /> BUILDING CONTRACTOR: CL G.K4f i 4[-YOo. -t+/L w <br /> Z � <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> 31 H Oj <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 00 <br /> v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO nI3 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'c O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 8 <br /> NEEDED. °» <br /> W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER CQ� <br /> SETBACK AREA. <br /> 5. to 1y�� ���/ ��.f f f�l9� 11/LQ, of t0E S E (A-00A b LC I, r <br /> ley I(� �r� �, /ri D _�P Y ( / m 3 cDi 10b, a f m <br /> 6. (� v ✓u/V aC -So SLR n ? /4000 � r e J T. 3 n m a D <br /> o �F-6La . - Sf m,t`I - No h wna� hab�tat�'�, Z 0 � o _ a <br /> Tom : 33 <br /> =v� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ( G>c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C 7 <br /> g, • m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize a m C <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> o <br /> CD <br /> SIGN HERE <br /> CL <br /> fA 7 <br /> (signature of owner or building cont ctt�or) (date) <br /> ZONING ADMINISTRATOR <br /> fA 69 69 fA — ro <br /> rr �J Ir 0 r13 ro <br /> C"Lnn 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �--te�"C� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />