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w-- ('P sky- 31 yo <br /> Burnett County,7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 c, Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> N <br /> 0 <br /> OWNER e4dre L.,f TELEPHONE 717 (0 5(0- C.jZ t Z 6 <br /> MAILING ADDRESS le;,)(1. 60JC 14-Z a.l1 � S`ll!a m <br /> r � <br /> PROPERTYADDRESS Q�I1'ed ��' O�Lee- P I <br /> LEGAL DESCRIPTION(see tax receipt) t ! CSS 1/,Q P�� �..A35 93z�{) //J.., LOT <br /> V J (�V <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑j, �C�AM�P�IN�G UNIT ❑ SUBDIVISIOa4m� <br /> DCSTRUCTURE/ADDITIONUSE: -3a Xs3� ogu ! $ X 3$ / 0`� o o , <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m n/ <br /> w <br /> BUILDING CONTRACTOR: <br /> w <br /> Z � <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m C <br /> CL <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m r D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I 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. LV <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 �7 3 U) <br /> MUST BE SIGNED AND DATED BY THE OWNER. 41, 51 <br /> o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI I!oq AE WHEN a <br /> NEEDED. � o <br /> C�; <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �� S 1 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFPI `vim XJ C <br /> ISSUANCE. AA II <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL hke7 r Cp ) <br /> 3 NOPERMITTED.GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 2OU <br /> I�{/�G � I /, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER V <br /> SETBACK AREA. <br /> 5. <br /> Ay <br /> 6. m wmr�imD � � <br /> m 3 am x -. m <br /> CD C y <br /> 7. Z u, mo <br /> P Te : <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 1 am responsible for the detail and accuracy of m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E <br /> t2that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is • m <br /> )2 <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 <br /> hat <br /> in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> ECD <br /> o <br /> ii <br /> authorized person t a e ecce .to the above described premises at any reasonable time for the purpose of inspection. m Cn <br /> C <br /> m o_ <br /> SIGN HERE V `��—��/ (D D <br /> Mre(sof owner orlllding contractor) (date) i a <br /> ZONING ADMINISTRATOR <br /> 0� TOWNSHIP PERMITS MAY BE REQUIRED d� r <br /> LA'a '" 'THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />