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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator - M o <br /> APPLICATION FOR LAND USE PERMITS . <br /> //�����ftAi) n/EN a te- ° o <br /> OWNER C/�Mael —TELEPHONE /S,ZSS, Ad)�] o <br /> v <br /> MAILING ADDRESS aSYX m O <br /> r m <br /> PROPERTY ADDRESS <br /> �9 859 GQ..+�6u� Go-a r7-u�E <br /> LEGAL DESCRIPTION(see tax receipt) oci <br /> DWELLING/BUILDING, GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ O <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT 11 SUBDIVISION ❑ a, <br /> S2. <br /> CA1AIA <br /> STRUCTURE/ADDITIONOSE: o <br /> (Hom/Caabbin; Commercial Business; Bedroom; Deck;etc.) c <br /> BUILDING CONTRACTOR: Y f� f C brii T���@.�LOV► �'iUL' 5�7��a9�7 w <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> n N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. ° <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N f r <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS ® 5. o✓,V <br /> MUST BE SIGNED AND DATED BY THE OWNER. - 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIQN MAl( BE r?NE,WHEN ° <br /> NEEDED. ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CU�) o W <br /> CONDITIONS OF PERMIT: U <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEED 7 ( <br /> ISSUANCE. 7QiN°(Nc" <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. n , <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,., ALLOWED WITHIN E REQUIRED WATER <br /> SETBACK AREA./ <br /> 6. / � accc� <br /> L/r�� _ nrDODO <br /> ��pp �ht � Imo-✓—� m w m M co n F <br /> �I " 7� Ctlonm 3 <br /> co S a m <br /> 6�` 'O N C(a to 0 7 <br /> ` V Z m10D O O (O <br /> 7. 9 m <br /> = rn: m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my : E <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of g 0 in C <br /> CL <br /> v 70 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 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- <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 ` m <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. T m o <br /> CD <br /> is <br /> SIGN HERE <br /> a ` <br /> (signature of owner or building contractor) ( I <br /> ZONING ADMINISTRATOR <br /> (XAiJ tniniHin�n�i <br /> (Vt CNn O (NJ1N 00 <br /> Ve I4- I`�D-U-TOWNSHIP PERMITS MAYBE REQUIRED UVJ <br /> V hC1 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />