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7D <br /> Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator -0 o' �'o <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> OWNEReir`ttiC.-ci )u�nilYr- � � S-3Z7—R�S3 C �� <br /> TELEPHONE <br /> 0 . <br /> CD 0 <br /> MAILINGADDRESS 112pS T(�PIS�r,rv� J�k—�c� Fre ,i� L.3S S�i _rJ <br /> PROPERTY ADDRESSrnL <br /> ion 3 <br /> LEGAL DESCRIPTION(see tax receipt) 1 I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION o �' <br /> TYPE OFPERMIT(S): Ic <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ o' ` <br /> STRUCTURE/ADDITION USE: Lkv�K Roar, o r,r 1 <br /> _f{�1(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn v i <br /> BUILDING CONTRACTOR: PQuti. <br /> 1:2 P <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m (J J <br /> N .J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ( n ` 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. 1 <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. 1 p <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE FILLED. C N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILD, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE RIFICATION M <br /> NEEDED. M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Q�/qA�t,, ���9 / o <br /> CONDITIONS OF PERMIT: 'YF� <br /> l�l�griy C /01-y � ` �'' N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P �/ <br /> ISSUANCE. 9j <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. I j <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> iW mmcDiCa0 m <br /> 6 .O 3 a m a <br /> m <br /> 'O m C y N O j Ti <br /> 7. Z w m o <br /> ° -n m <br /> declare that this application (including an accompanyingschedule has been examined b me and to the best of m —r^ <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 In 0 : (0: C <br /> CL Ln : <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m 0 : In <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 I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hav access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> CD <br /> SIGN HERE '3-Z 5;- D�/ m <br /> y, w <br /> (signatuof owner or building contractor) (date) ' a <br /> ZONING ADMINISTRATOR I�Y) �111Gfa�1 <br /> Q 'Lq 49 64 6S I") <br /> N) 0NN 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v, 0 u, cn O o <br /> > 3 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />