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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> CD APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> r✓i2, Y��r 4937 <br /> OWNED /^1/ ,fl 1 TELEPHONE <br /> MAILINGADDRESS <br /> � r <br /> o <br /> PROPERTYADDRESS 3O�G k,�S Yd1-►- GcJi �� S� r `` <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> DWELLING/BUILDING ❑ GARAGE/ACC SORY STRUCTURE ❑ ADDITIONL][J Cn <br /> TYPE OF PERMIT(S): � \ Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> //�� (Home/Cabin, Commercial�Bu}siness; Bedroom; Deck; etc.) / co <br /> BUILDING CONTRACTOR: K 'V-b) -C //C/iLtdCG��� 1�'S�e/� (�y/STY o V) !� <br /> � � J <br /> -o <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p _ <br /> 0 C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O 0. ( J <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 m <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 m U <br /> CENTERLINE OF ROAD,(C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o d <br /> CONDITIONS OF PERMIT: <br /> — i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT + <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t`Jf <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 <br /> SETBACK AREA. <br /> 5. oAwt4 ELGvhTro+o of 95'.37 REfRCwCW To 84JCN MA4K 402-A 0 /W.00 i 401k X W 0 r D O D 0 v <br /> {6- Cow ere6e- Spit 6f R TV Tiw6A. 4* ihG Cu E at � m c: m d ° m a f m <br /> 6. 9 ESO O F Dite+J RoAo, qE m x 3 a 2 x R ;u <br /> aft E[.SUA'TrrW OF 98.7e1. ° o C <br /> Z C y N ° = f0 <br /> 7. O N -n C : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — O <br /> PP ( 9 Y ) Y Y C) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' °_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ° <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° to <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 w o <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 rea ection. ° a <br /> -n <br /> N a : <br /> SIGN HERE41g <br /> st to, of owner r uilding contractor) ( te) �• o <br /> 0 i <br /> ZONING ADMINISTRATOR SEP LO 2004 <br /> i 9 ur vn <br /> aog�ID- gam C -N(nwWN0 <br /> T NSHIP PE MITS MAY BE REQUIINETT COUNTY ° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ROMCE <br />