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- CSYIG <br /> 'Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N � <br /> N <br /> C <br /> W <br /> OWNER �R-A�� 'TIlC-Ie7 TELEPHONE �3(;7 <br /> O <br /> HOME ADDRESS 27"51 7F4N ( t�c� ti9EP ST�IZ k,*T S;Lf ItIt3 0 <br /> 37 <br /> EMERGENCY/FIRE NUMBER `a,") C( —7 -7 ROAD NAME &A4,-PID t-Ic.- 1 ~ <br /> I) <br /> LEGAL DESCRIPTION (see tax receipt) SIE% A-�Tto <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ N 00 <br /> c <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 95. <br /> : <br /> N <br /> STRUCTURE/ADDITION USE: G ky—O'C„ t%d4 c lr,On 40 Pcw 1L CCr.✓'S = - <br /> —{ (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 1 t E �O�`SZ G1 <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0C <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0m <br /> n n <br /> -n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m n <br /> NORTH(N). (A 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (J) <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF L9 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. l <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRI�UED FILLED. t N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUIL DE E PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V IFICATION MAYBE DONEWH 1 q 3E <br /> NEEDED. OCr --5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o t <br /> CONDITIONS OF PERMIT: SURNE77 G`OUN CN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERf�NING N <br /> ISSUANCE. I <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 <br /> SETBACK A/REA. / / �57<111 1'4. ✓ Geri e/ <br /> 5. ` j M2 G� S`1 Dom!` �u �r / <br /> Ppo/ '�l f.�� CD CL X 3 r o C m <br /> s. �A)b d1> � 1 o vi / ��,-cc( 72, 6 e Cir L Chi / 'j �N y o s 3 <br /> 7. 7U S /"�` a� t t G/YI�Yi u1A1�1 IO "D o y mil , <br /> -_uri. ' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize rn m m <br /> that this information I am providing ill be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all li lity which may be a result of the County of Burnett relying on this information I am d E <br /> providing in this application. I agr to permit county officials charged with administering county ordinances or other E m i <br /> authorized person t ve access t he above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m : <br /> SIGN HERE I[� Li— 01 <br /> igna re f ow wilding contractor) (date) <br /> ZONING ADMINISTRA OR <br /> 3 V7 G11 0 (n V1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />