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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER CPKE&o" A. *upp�'r TELEPHONE C11✓5)L'.j�- 1-775 0 O <br /> 11 m <br /> MAILING ADDRESS WCi1-76 1040 i� R\V IZ r-ALLL \,A3T� SLFOZ� v O <br /> o <br /> PROPERTY ADDRESS <br /> Hi I I pr <br /> LEGAL DESCRIPTION(see tax receipt) LOT � ` C5NL*'3738 5 � G m <br /> W - - 1 -yl- tb . <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ d' <br /> o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ q <br /> STRUCTURE/ADDITION USE: DSI', 0 G 1 <br /> a� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) l' <br /> m <br /> BUILDING CONTRACTOR: AIA <br /> U <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 � 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m '? <br /> NORTH(N). <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 ' <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. G� o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> ti o � <br /> � // Q` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC p� 7 �I7 <br /> o !' <br /> NEEDED. �/� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. `/ / Z <br /> ©€r o Q <br /> CONDITIONS OF PERMIT: <br /> /.�/� ?Op3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERA�fIT'RIVF <br /> ISSUANCE. <br /> I <br /> 3. NO GRADING OR HIORE2. REMOVAL OR CUTTNGOLAND ALTERATIONS AREF TREES AND VEGETATIO LLOWEDTUNLESS SPEEC F CALLIS RESRICTED ALONG YLINE. �O�IN o�Il/ y <br /> PERMITTED. 'V�7 r <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., <br /> ALLOWED WITHIN THE REQUIRED WATER (� <br /> 5. ��SETBACK AREA. !N1�v -_. ' '�`„ ' � `� _ (f w <br /> ���/r ll�n �7� <br /> 6. �lS�1 N—(0—Q3 p [1� CPU 9 e2 `E-61CL✓) /6�1 fi'Cjyy7 m a m <br /> nm xo' ' <br /> 7. �� �� � ` ry C N m <br /> i m <br /> I declare that th' a lication Includin an accom an In schedule has been examined b me and to the best of m i A <br /> PP ( 9 Y P Y 9 ) Y Y /Inn G), <br /> vl <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C n v, C <br /> CL cn <br /> Fa <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 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- QJ G <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 E m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ' <br /> authorized person tp 11ave access to the above d scribed premises at any reasonable time for the purpose of inspection. m S <br /> - o : <br /> m � m <br /> SIGN HERE <br /> (signature of own ullding contrac (date) <br /> ZONING ADMINISTRATOR <br /> dtD 69(A <br /> p N UnN 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED `�(J� �`((�U (n o`n`n o 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 1\� l <br />