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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> OWNER_Tf,� 2. Y kylrE; 31 M ICr cs TELEPHONE <br /> m <br /> MAILINGADDRESS I QQZ Lit), <br /> f<�.I,J (,/ TT PAt� Al'i 5ypp <br /> CA <br /> PROPERTYADDRESS �T'S'o�' I�i1C�'L�/'G�l//�� �iQ�'`� IL�IU <br /> LEGAL DESCRIPTION(see tax receipt) TLI 11 tj <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn 0 / <br /> TYPE OF PERMIT(S): c V� <br /> FILLINGIGRADMG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; C mmercial Business; Bedroom; Deck; etc.) Co <br /> BUILDING CONTRACTOR: 5VA 73T✓ It m <br /> Z � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'r <br /> O <br /> 0 Nl <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) On <br /> .n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <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 3 <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. I 9 <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 /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. d',a o <br /> O 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » o InJ\) <br /> NEEDED. YJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J ✓yJ <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 WATER5. (� <br /> $ETBOACr A AREA <br /> . '^ 1/� p�--� n n/� IDb� t� 610-ser <br /> / /0 sp (h 75 <br /> �. �� <br /> A ar O r D O DO <br /> DHwm- m cmdom oFm <br /> 6. m x. 3 R �ci- a1= A <br /> 9 Q N C y N c J 3 <br /> Z c m' N O (O -4 <br /> �. O 0 : <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y ) Y Y a G) : c <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 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 G i M $ In <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- N <br /> L) : 0 <br /> sue a permit. I further accept all liability which may be a result of the County of Bur e � I � m � o <br /> providing in this application. I a ree to permit county officials charged with admin t 1 bUnTy r n or' thy¢ <br /> (t <br /> authorized person to have ac c,the above described remise t any reasonabl f, <br /> SIGN HERE9 <br /> ( g ature of owner• b ' in contractor) ) Uu <br /> ZONING ADMINISTRATOR R 11 <br /> ZONING <br /> O N O N N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> .--WIS PERMIT SHA L EXPIRE O E Y R FR DATE OF ISSUA E <br /> �F-t.11Ytit%+ ,i- 1e�� mQ �D �m Mals <br />