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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 /> /7 ,/�`' r N D y 03 <br /> OWNER VAr•tK�F L� � TELEPHONE 1�S- 0 6_._ LA 310 f , <br /> O <br /> m <br /> l�'A ,.� Me ni <br /> MAILINGADDRESS fj� ^to S� C('b�X �VC fJ b ,•`' Lr) Mt4 S51taa / r Z—�2- O <br /> o 1 / ,/� t U <br /> PROPERTY ADDRESS a91S� L4Sr 4r J �vc+ ,cC 0/���Uty 5036 <br /> LEGAL DESCRIPTION(see tax receipt) O <br /> 4 <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> � v ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: .� ���Q 0 <br /> (Home/Cabin; Commercial Businesy, Bedroom; Deck; etc.) cn <br /> Se�F <br /> BUILDING CONTRACTOR: m <br /> ,2 r . <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n J <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <br /> NORTH(N). CA S O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m .o <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. 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 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. o <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o w <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z J <br /> CONDITIONS OF PERMIT: o O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N t <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 G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M c W mr>i m c, :E rmrt <br /> 6. m 33m 0 A <br /> 15omcN . og3 <br /> Z cymo : � -i <br /> 7. O <br /> — N : IT <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of D n <br /> v : <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m IT <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 r o <br /> P <br /> in is applic I agree to permit county officials charged with administering county ordinances or other m <br /> authorize perm to ove achas to the above described premises at any reasonable time for the purpose of inspection. m <br /> > : <br /> n : <br /> SIGN HE <br /> (signat rete ofowneror building contractor) (date) W <br /> ZONINGADMINISTRATOR <br /> V�fA fR �N <br /> O U O T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHA L E " <br /> PIRE ONE YEAR FROM DATE OF ISSUANCE <br /> i��mil e +err�lcLid U)OhL4Barry L�Isoh �-� �6 <br />