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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c) Z <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> Fl 6 3- Llgl- `7 515' <br /> GWNERG e r r u h TELEPHONE 63-a 3a- q j1 (0 o <br /> MAILINGADDRESS G9°la TrbSt oo (qr pycK MM 55330 v <br /> PROPERTY ADDRESS <br /> �1 C►� ( ten IJv un If a S) ren <br /> c P) e Twp 3q3 N 12tiG I taVJ SyB7a G N <br /> LEGAL DESCRIPTION see tax receipt) <br /> DWELLING/BUILDING;M GARAGE/ACCESSORY STRUCTURE ❑ ADDITION o <br /> TYPE OF PERMIT(S): c <br /> Q <br /> FILLING/GR DING El CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: lel�J I Yl Reroo-F -t- i�.P�l (..141( a., <br /> (Home/Cabin; Commercial Business; droom; Deck; etc. N <br /> SCh <br /> BUILDING CONTRACTOR: f� Irh I <br /> v � <br /> m <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. ''n 3 W <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) O m <br /> � a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o 1 , A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 3 , 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. 1 <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 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN -S)� <br /> NEEDED. /V'�J 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C]7•! <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER d <br /> SETBACK AREA. <br /> � 9� <br /> s. SrYu.-4cl &t 4-vFwtt a,— (5 sfi/f1E I <br /> 6. ' <br /> W, /'.rl ,7/eh �(/�J{- 1" i'vc-eed �V0CJAea� VLC1tu fe'�GST/ myo , <br /> .a 0N '^ 05ic <br /> 7. must apply -fV� (UU) �r� nurnber�r 8`31 -D6 0 , m <br /> I declare that this a lication (including an accompanyingschedule has een examined b me and to the best of m <br /> PP f 9 Y ) Y Y <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 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- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am o <br /> providing in this application. I agree to permit county officials charged witha i o or ,o m <br /> m : <br /> authorized person to have access to the ove described premises at any reasol2 e o f', n. <br /> T a <br /> m <br /> D: <br /> SIGN HERE <br /> (sliga e o owner orb ' ontractor) ( o <br /> ZONING ADMINISTRATOR 42 <br /> JUN t 9 & <br /> BURNETT COUNTY O N U W W N O <br /> TOWNSHIP PERMITS MAYBE REQUIRED ZONING � <br /> TIP&�M IT Stell e IRE O,�JE YEAR FRAM DATEISSVANC <br /> "r, ^ �� <br />