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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ur r <br /> o <br /> OWNER iG I i7� OL �Dl:^a� IJ�� TELEPHONE —171,91— <br /> ` �a?9 0 " I <br /> MAILINGADDRESS <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ® ADDITION ❑ �N <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT/❑ SUBDIVISION ❑ �� � � � <br /> STRUCTURE/ADDITION USE: ir-n 44 ,01, 4 tYa1//'-;0 .. Se e�T £ 0 (� <br /> (Home/Cabin; Co mercial Business; Bedroom; Deck; etc.) to <br /> BUILDING CONTRACTOR: Sf/tC /�sS �£JEsL 4� .[ACAC/SUtl CD�JK-fy`tleS <br /> v <br /> m _ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p - <br /> M u <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O n (� <br /> T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). C — <br /> ' n' o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m v l R <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. 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. <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 `i <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 0— <br /> NEEDED. <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z L <br /> 0 <br /> CONDITIONS OF PERMIT: 710 <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. n <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. r <br /> 5. -fjjI S 5lfU,,jg ' fV be used A.S prit�e- rtstd�41 l-J j rase Dnly- <br /> U- 1 l` � U",, / A tb O r D O D O M <br /> ITt /fJ I'I r lG(aJt '�Zah , m c d m n m a f m <br /> 6. m x3 nm xa �= .'O <br /> vam Cy . o � 3 <br /> 7. Z cinmo : <br /> O m A <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — °'' A <br /> PP ( 9 Y ) Y Y I ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> m <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am E S d 1 0 <br /> providing In this application. I agree to permit county officials charged with ad i uatY, - er ,o ' m <br /> m : <br /> authorized person to have access to the a ve de remises at any reasorra I= r r i <br /> T <br /> m D <br /> SIGN HERE <br /> a : <br /> (sign r owner or building contractor) A <br /> R�G d# L l . <br /> ZONING ADMINISTRATOR ( U <br /> BURNETT COUNTY O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIREDo o v u o <br /> ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DAT qF��SS� �U_ANCE <br /> �t #/-l'�amp 9-1/-Dk <br />