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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 Z <br /> APPLICATION FOR LAND US PERMITS 3 <br /> e..Kt g6,_ '9A 1.3 N <br /> ����11�7 LL� /t'1� e ( <br /> OWNER �O W V nII' IJ It trlkIIId TELEPHONE, I p �C9m 4tIX� n <br /> MAILING ADDRESS U O <br /> W 1 AJ RR o <br /> PROPERTYADDRESS �0� � �t?. I ry �Q 00 g <br /> 1r VV <br /> LEGAL DESCRIPTION(see tax receipt) <br /> C7 rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ to p <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CLING UNIT ❑ SUBDIVISION ❑ Cr <br /> mac alJd I ,�I�� k(g�,lra tTf p <br /> STRUCTURE/ADDITION USE: V N <br /> o' w <br /> (Ho /Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> F ' <br /> BUILDING CONTRACTOR: 1 Cs�e, �',SD GD N <br /> v <br /> PLOT PLAN MUST BE PROVIDED LEAST AN 6Y,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> NED. �t <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 " Q <br /> O m <br /> T n <br /> t. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE A <br /> NORTH(N). <br /> m m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v 3 <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. O, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC,,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o Q <br /> o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. o <br /> NEEDED. � Di <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o Q pp Q t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT „'' I \' JI <br /> ISSUANCE. ,� O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. CN <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 C) <br /> SETBACK AREA. d <br /> 5. <br /> 6. y > 0Da O -0 <br /> 3n xa � ,mL <br /> m x <br /> 7. O M C N y O J <br /> Z C h N O O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the b <br /> : m <br /> est of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m n u S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �' m ` m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- cn <br /> Ci m O <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 o <br /> providing in this application, agree to permit county officials charged with administering county ordinances or other <br /> authorized person ttoo�have acce to the above described premises t any reasonable time for the purpose of inspection. ' �^ <br /> O o <br /> SIGN HERE D m n <br /> a : <br /> (signs re of owner or building co ractor) (date) p <br /> FIQ� I n ' <br /> ZONING ADMINISTRATOR m <br /> f fA ER N <br /> TOWNSHIP PERMITS MAY BE REQUIRED d N u w o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> o o <br /> �perm(-1 4- le4f-,01Cied Up by �d (�fe sOn � -31-0 � <br />