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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> y <br /> c p� C <br /> OWNER TELEPHONE lv51 - '73 f - '/21— _Q�\+ <br /> MAILINGADDRESS 81493 i� ��DEO /L1rA�4j , t)c0Dej(,�ke—%/ nAj S�/�� O <br /> r <br /> o <br /> cm <br /> PROPERTY ADDRESS `JwJ`�'T I- nl�t� Ll (�I�/}DE �/�Y- ` z— <br /> LoT 3 L-I,-tom TSA aE L-A1<-=— G;n-�T LOT' 6 4 C— VA <br /> LEGAL DESCRIPTION(see tax receipt) _ 3-7CD <br /> C <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE © ADDITION 0 1�.. <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRjJADI�DIN��G1:1 CAMPING UNIT ❑ SUBDIVISION ❑ a' (� <br /> STRUCTURE/ADDITION USE: T/v-f� � y�� <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) rn <br /> r�ar►� <br /> BUILDING CONTRACTOR:�F�.Jr. �/�.3 �� G.�STDr1 �'S �' m � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 00 - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> -n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m T <br /> NORTH(N). (n -, 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 _ dOZ <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. ( ::E <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o F <br /> O � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. <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 C <br /> SETBACK AREA. <br /> 5. &n"; .4Le. 101-710q k <br /> CD C m r D � CLO M <br /> a f m <br /> s. <br /> omcy `� o' � 3 <br /> Z c rn o <br /> 7. o ID n < : 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 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 m c m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- cn : O <br /> G) : =r : <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 W o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasont `D <br /> -n a <br /> DSIGN HERE d��.� n <br /> (signature of owner or building contractor) (date) ? ? i <br /> w <br /> ZONING ADMINISTRATOR I OCT A 2004 <br /> lfl 4A(A(A N <br /> O N (T W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> BURNETT COUNTY c> o m o cno o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUfiglab11NG O <br />