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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c� Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> 0 <br /> N O» <br /> N <br /> C L t� ft <br /> OWNER S't G(l e � J�'/I Q M`y c�G 1\ TELEPHONE 6s!a�7—6 /.�7 O <br /> d <br /> MAILING ADDRESS �'a �� N�GSanJ Liv Ce1�fC'r / . her/ SSD/m2 v <br /> 0 <br /> PROPERTY ADDRESS a d 3Q 8 SSS fl R01 <br /> LEGAL DESCRIPTION(see tax receipt) `p 8'v cn <br /> CD <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING U ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONOSE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: lilt r B6.f4)7A) Rt <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> rTI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p o <br /> m <br /> T 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 T <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 7t <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ? l <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 OR FILLED. N <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. <br /> ° F <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENo <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 <br /> SETBACK AREA. <br /> 5NC — �� <br /> am o > 0 > 0 fD .V <br /> 6. m <br /> $ 3n <br /> mroa- � <br /> C N o 3 <br /> 7. z inmo : ''01 <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my — A <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of iu 0 A C <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- m <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 char edwit g county ordinances or other <br /> authorized person to have access to the above described premises ji!"Or the purpose of inspection. m ? <br /> o : <br /> SIGN HERE �.�� . � ? <br /> (signature of owswwor building contractor) `1�1 2 2003 (date) o- <br /> ZONING ADMINISTRATOR <br /> (1�fTOO <br /> ��1RNETT COUNTY 0`" ' N <br /> G N N N O O <br /> TOWNSHIP PERMITS MA E RFL� <br />