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Burnett County"7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> m � <br /> m <br /> c <br /> D <br /> OWNER //J OTL OG/S/t! � o <br /> /J m <br /> MAILINGADDRESS o�7 d DOQ,•LnTir 1..4K/8 Y`'0, 90e o275 WFP'ST`tIZ SY8`7�_g O <br /> 0 <br /> 0 <br /> PROPERTY ADDRESS n n i?--r n TT L A u 9 (1-0 E aS?4Q <br /> LEGAL DESCRIPTION(see tax receipt) 3 '�M V 1 S/ P 2aa b , eG 3 J. , T HaN R / (,ijCn CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® rn 0 <br /> TYPE OF PERMIT(S): / v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ // l/ n <br /> STRUCTURE/ADDITION USE: /� C(( �u�^O ' o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc. �12�+�� U) (!t <br /> m <br /> BUILDING CONTRACTOR: ` ec'E K; S ac les COW, �TAw 'S' nrnc. d LA <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T ^O _. l� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a "1 <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i A <br /> NORTH(N). N o� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 33 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF t V, <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED-QR FILLED. N 5 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, COT TC., THE PLANS 0. V <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> ,� G I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC TION MAY B �H� o <br /> NEEDED. Mq yj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. t7 o V7 <br /> CONDITIONS OF PERMIT: gURNE <br /> 1 DRIVEWAY <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Z N N�UN7Y <br /> SS 'Qr� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. L <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY KFC(((J]�,/ <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER - „ <br /> 5 /SETBACK ASA. 77—U3 <br /> d <br /> 6. 8 3 am COD 0.R ;U <br /> N <br /> 7. Z N O <O <br /> O T <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o n en <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o v <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 d <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 o <br /> m m' : <br /> SIGN HERE/ -a 00.:3 a <br /> (signature of r or building corg"r) (date) <br /> ZONING ADMINISTRATOR O <br /> EA EA f fA — N <br /> �3og9 27-33q N N (TNNO <br /> �� o0 � o0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> o26S-z/ qty t. <br />