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Burnett County 7410 Co.Rd. K,No.102,Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> rn O C� <br /> 4! <br /> OWNER C//c keV LCA TELEPHONE 7� 3 - 7`jS`=017 '/J 'a Z <br /> n <br /> m <br /> MAILING ADDRESS T-H.4� ti t,� 3 3 v <br /> n <br /> 0 <br /> PROPERTY ADDRESS (-e (� M1C4 f L L iC. �Q/l/ k/L <br /> a <br /> LEGAL DESCRIPTION(see tax receipt)3ere;r! O T�().A �� /li �S ivt✓�J��7 m <br /> DWELLING/BUILDING I� GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ SWN o <br /> TYPE OF PERMIT(S): �( �I C S w! ' <br /> u o <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: X 3 0 RJ <br /> � (Home/Cabin; Commercial Busin ss; Bedroom; Deck; etc.) m <br /> D bi <br /> BUILDING CONTRACTOR: / / L L Ex- leo ou 3 T fir <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p y C— <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n .� <br /> '—f o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 a <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. t N 0 <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 Q� <br /> v I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER � ESY)l N ° (� <br /> NEEDED. �l�l� <br /> LIU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I RpR c <br /> CONDITIONS OF PERMIT: , J p„4 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF E �u(/4 (� J <br /> ISSUANCE. >^1T COU p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREI-140/ IA/(; loy <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY R <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. jG 4—a60/q — C ,C j0< <br /> 6. <br /> m 3 nip x a <br /> 'O ftp C y <br /> 7. Zy y o 79 <br /> =Cn: m <br /> declare that this application(including any accompanying schedule)has been examined by me and to the best of my G)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 E» <br /> CL m . <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m e my <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. 1 further accept all liability which may be a result of the County of Burnett relying on this Information I am ro <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 reasonable time for the purpose of Inspection. m m o , <br /> CD <br /> SIGN HERE d' n <br /> LAI (signal f owner or buildin ractor) (date) <br /> ZONING ADMINISTRATOR �' ` '• <br /> Ge 69 Hi fA�+N <br /> TOWNSHIP PERMITS MAY BE REQUIRED t-.J( <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 6 '"r <br />