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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator T ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> UT <br /> UT 0 <br /> OWNER E�` jD JJ'r) TELEPHONEj !6 3 ' 1 / <br /> i y � <br /> MAILINGADDRESSy 7� �s <br /> vd <br /> a <br /> p-Pr �, P, N <br /> T � <br /> PROPERTY ADDRESS7 {' jam <br /> Jl!Y�q/ I1 <br /> LEGAL DESCRIPTION(see tax receipt) L rte( <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ElW 0 <br /> C <br /> FILLINGlGRADING CAMPING UNIT ❑ SUBDIVISION Ela <br /> a <br /> STRUCTURE/ADDITIONUSE: /� `J / 77� / )/�(�I//� Jjfl �1 (�(fZ� o <br /> (Home/Ca n, Commercial Bus ess;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: Y W b4?Ck, f C✓er W (1 <br /> v <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 c <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y \ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m I� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING � <br /> S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF l W (J� <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. <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, CM <br /> �{�THEP—L��uANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. MVIi7iEtll NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI Co <br /> NEEDED. I / <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1 OR 2 2 ?�3 Z l� <br /> CONDITIONS OF PERMIT: BURNETTo I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT COUNTY Cj' <br /> ISSUANCE. ZONING C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 6� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. (JI G <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �I <br /> SETBACK AREA. <br /> 5. Ns{& q-06-03 Ill eqW ` &CU oP6 85' 76D a.#. W ln- <br /> 6 m W y D O D 0 M <br /> �O 3 'nm OXaID <br /> 7. N C <br /> Z N (D O 1D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my —� p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of I� d r`, d, S <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- p <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 charged with administering county ordinances or other m <br /> authorized person to have ccess to the above des ri d premises at any reasonable time for the purpose of inspection. m <br /> -n <br /> y/ o <br /> SIGN HERE L �, <br /> (sign of owne or building contractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> fR fA 69 fA�N <br /> N t T N N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Si � � `�`� 0 <br />