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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> 0 <br /> OWNER 1 `1C4tor .y O (�- �GL5" L TELEPHONE (2 (J Z-) 2-Y2- <br /> -493I -J <br /> CD <br /> MAILING ADDRESS 4)1 <br /> / C r m <br /> PROPERTYADDRESS J y�! �i�� Z <br /> V -,4,VF SP(�U/✓ G✓r J yoo �D , o <br /> LEGAL DESCRIPTION(see tax receipt) LQ j 2 6G�I el✓ / ;/Nse 3N, Afw66- / //N <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE W ADDITION Q m ° <br /> TYPE OF PERMIT(S): (� o <br /> FILLING/GRADING ElAMPING UNIT ❑ SUBDIVISION ❑ IT a <br /> STRUCTURE/ADDITION USE: / I M E �C t4Bi Al O <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc. m <br /> BUILDING CONTRACTOR: CE Co vS-r 2't c -//On/ C S C O j 7 7^'VY- '- <br /> S— S� 42 6 4e IfsUSL cw S, S•►.I I;�PS �9�5 <br /> CD <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. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <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 <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. 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. a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. M <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILD TRACTOR, ETC.,THE PLANS 0 S� <br /> MUST BE SIGNED AND DATED BY THE OWNER. / I ,o o <br /> 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE//VERIFIC 1 w JJ ,", WHEN o <br /> NEEDED. ��! M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �? '� <br /> CONDITIONS OF PERMIT: %)C 3411J/Jj o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OICO <br /> ISSUANCE. PN/ UNTy <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 (J� <br /> SETBACK AREA. I <br /> he <br /> 5. or1 �S1 t-^oa � i�e �n <br /> 6. � [Ca / / I v /t tl , m m°r' 00mOaFm <br /> m CD 0 0 m W <br /> CD C m °' O �+ <br /> 7. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ' <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize CD 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 v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> -n o <br /> J1 CD m <br /> SIGN HERE <br /> (signature ofow or wilding contractor) ( ate (� U. o. <br /> ZONING ADMINISTRATOR <br /> ( � S PERMITS MAY BE REQUIRED N�(a 7� U— tt P <br /> TOWNSHIP PET OQ T O O <br /> 3 J141 C� <br />