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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U 0Z <br /> APPLICATION FOR LAND USE PERMITS . °� <br /> pEC� G'o.vSr' 4 c ria.o �, � o0 <br /> 7�S- .2s 3.2xo m <br /> OWNER i'-h o m a s `d` GL'OST�- TELEPHONE G si -qr'7 774 n <br /> l 0 0 <br /> CD <br /> MAILING ADDRESS �Z')f SO/�l�.�Se�7F ��� /! /yJN �j//8 O <br /> r m <br /> PROPERTY ADDRESS 67 <br /> o- /c/ L s s-19- CS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE C•❑''/ADDITION ❑ v\1 ` o <br /> TYPE OF PERMIT(S): ` CDS <br /> Sv <br /> FILLING/GRADING CAMPING UNIT El SUBDIVISION El CL <br /> STRUCTURE/ADDITION USE: S LGCICQ/ c pd <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) /, <br /> BUILDING CONTRACTOR: TA'G/C PECK 7/S- .2s-q_ 3.2AC rcl �� ? F ' <br /> 426 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANNCOMPLETE OR 3 <br /> Y I (J <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �F'I <br /> y !�. <br /> DIRECTIONS FOR PLOT PLAN DRAWING M(AERIAL OR TOP VIEW) O a n l� <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 <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK (OHWM)OF c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. L,c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTA CES 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 Oti <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIO '�l"IA pt� <br /> U y� y O <br /> NEEDED. �. �()r�; <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I � o <br /> CONDITIONS OF PERMIT: 14AY 4 % <br /> 4.0 / ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF SNE <br /> ISSUANCE. <br /> 2. REMOVAL OR <br /> OF TREES AND VEGETATION IS RESTRICTED ALONG <br /> NG <br /> 3. NO GRADING OR SHIORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY LLINF� NG <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m\W 0CDa:Em <br /> 3 CL(OD Dam M <br /> CD C <br /> 7. y m O J O <br /> T <br /> O G : 2I <br /> I declare that this application(including any accompanying schedule)has been examined by me and to t e best of my �j : D <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail an accuracy of Uy m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare th t I recognize �I m � : o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining i hether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this inf4 rmation I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinai ces or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ' (D '. cb <br /> m o <br /> SIGN HERE „�/� �G�2i/Z�i 3�- C (D m <br /> (signet towns or!wilding contractor) <br /> (date)I ° o. i <br /> ZONING ADMINISTRATOR <br /> N�fA W 69 N <br /> (Nl1 O (071 (n O0 <br /> /)0 � /\� TOWNSHIP PERMITS MAY BE REQUIRED <br /> `� Q�`CHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />