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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -UC) z <br /> APPLICATION FOR LAND USE PERMITS M_ <br /> r <br /> y O <br /> OWNER L ,Aj S , 1 TELEPHONE ;z�� 3�` y�y 4 <br /> MAILINGADDRESS bit) 1122kNuo n0 �Cn <br /> cr, Is iiw 1 FL.. 3LIIyr `- O <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 5;ta j Z07 .fel-- /0 T 'f ✓✓/4 Q l7 V <br /> DWELLING/BUILDING X GARAGEJACCESSORY STRUCTURE ❑ ADDITION ❑ rn a W <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑CA <br /> UNIT ElSUBDIVISION ❑ <br /> �'+ n <br /> STRUCTURE/ADDITION USE: l,4 iUJ{ 0 <br /> 1111 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N n <br /> BUILDING CONTRACTOR: kAQT oT- `lt'C- k)omi LLL, V , <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) p m <br /> T n <br /> 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 Im <br /> NORTH(N). a <br /> _ <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Cna3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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. K/ <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 "( ' <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> Q o 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN sp 0 d <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z W <br /> CONDITIONS OF PERMIT: P 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Ln <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U,J <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 <br /> SETBACK AREA. <br /> 5. <br /> m c� m N n Dn <br /> 6. m <br /> 0 > 7000. <br /> m x 3 n m x A <br /> o m C <br /> 7. Z <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y i O c [ <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 I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' `� in <br /> sue a permit. I further accept a I liability hich may be a result of the County of Burnett relying on this information 1 am m o <br /> providing in this appli n. I rs permit county officials charged with administering county ordinances or other E m <br /> authorized person ave acc s the above described premises at any r seaab rt ot4gspeclion. m <br /> m n <br /> SIGN HERE <br /> (signature of ow or building contractor) (date) j i i ' : <br /> ZONING ADMINISTRA R FTnnl Q <br /> A s » <br /> �fA fA fA fR� N <br /> O N N W W N O <br /> LJU <br /> TOWNSHIP PERMITS MAY BE REQSkMNETT COUNTY o u o u u <br /> THIS PERMIT SHALL EXPIRE OIJE YEAR FROM DATE OIZ19k QCE <br /> ID y W"4-off 4 ,.& kAf4) <br />