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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> W O <br /> N <br /> C <br /> ff �^rr '9?-9 <br /> OWNER �`C�k G�.St (fir lJ'1✓I� '1/���r TELEPHONE �12� O Z 3 "oO � n <br /> o <br /> m <br /> ,^ h <br /> ' ' I O <br /> MAILINGADDRW ESS Z,?-JL , /"`I V -(, r 4k4j P ICW y <br /> PROPERTY ADDRESS 3: -43 Mey.e ✓'s VoQ d a n b ✓,� / S`f �'3 0 <br /> CD <br /> LEGAL DESCRIPTION(see tax receipt) Pay-+ 0 T U V Lt- 3, 15 W <br /> CD <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> C <br /> N <br /> Abi v� '� . <br /> STRUCTURE/ADDITIONOSE: �t'ls�t(� "�aS'� �T�n �iS 0 (� <br /> (Home/Cabin; Commercial Business; Bedroom; ck; etc.) ( — 23- <br /> BUILDING CONTRACTOR: S-teVL � ��� / M ) kc. -Farv`c rfC)� <br /> Z <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O -- <br /> M c A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> -n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO RI (••3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 /> 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F t <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN N» ° <br /> NEEDED. (Z> <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o t 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. S (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �✓1 Q <br /> PERMITTED. v' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,AL OWED WITHIN THE REQUIRED WA <br /> SETBACK ARE- <br /> 5. LASS r d ✓" �-"c f7 A co0r- DODO 'U <br /> m c wm n m n * m <br /> 6. m �'c3oCD <br /> 00 ° ;0 <br /> 'o =r m C y m o 3 <br /> 7. P m Tom : <br /> _ cnm <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C_ C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> O : =r : <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. 1 agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m n <br /> m D <br /> CD <br /> SIGN HERE <br /> (si ure owner o ui ing contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED p <br /> THIS P MIT SHALL EXPIRE ONE YEAR FROMI DATE ISSUANCE, <br /> t�nm-, r t I I'�( m6.l I eel 4--D `k i C L I S,- <br />