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Burnett County 7410 Co.Rd. K, No.102, Siren,W1 54872 Office of Zoning Administrator 4 I p <br /> APPLICATION FOR LAND USE PERMITS (}7 <br /> L� yy�� LL A TEs aU,J,7 <br /> OWNER iowlt �I� i`4Fa� Kr,I � SQ ONE <br /> MAIL ,U88 g7t.1k n11y z4 titks WL Cyd;;z <br /> �o ' <br /> PROPERTYADDRESS <br /> t <br /> y <br /> LEGAL DESCRIPTION(see tax receipt) II <br /> pWELLINGIBUILDING RCTIVJ1+ GARAGOACCESSORY STRUCTURE ❑ ADDITION ElV a N 9 <br /> TYPE OF PERMIT(S): 0 4. <br /> FILLINGIGRADING''1❑1 CAMPING UNIT ❑nn 1SUBDIVISION El <br /> STRUCTURE/ADDITION USE: 3 B f LJ Ik e..�1.73 �RCcIv.L. FN - <br /> (HomelCabin;Commercial Business;gedroom, Deck;are.) in <br /> BUILDING CONTRACTOR: <br /> AS� .& PO.�¢ SYJ IJeLsyK, f+1T j'�893 �' <br /> w <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6K X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O F / i♦ S <br /> D x <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) O n <br /> T <br /> T Q Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C, a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE _ <br /> NORTH(N). m <br /> C 1 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO IvH1 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 0 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND GRAINFIELD(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. Q c W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS y 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o <br /> NEEDED. 16 <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. O <br /> .� <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <br /> ISSUANCE. <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C" <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. 57A?1G THAT' <br /> s. WACNdd C,,LTlr+do AaP By CNIAIES ,)'3pu< .Vol 5 CSM pf 1$6, <br /> THE "Aill Cr.,, 66 S>e01010® '&r. T6r0 Co64 Ce..Q/JAvT Ar X. `[t,-- <br /> 6. <br /> z a x <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me end to the best of my 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all Information contained in this application(inclutling any accompanying schedule)and 1 further declare that I recognize m m ? in <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- c1; <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing iAholum I agree to pestering county ordinances or otherauthorizdv c as to the above tlescribetl premises at any reasonable time for the purpose of inspection. r <br /> Ya as <br /> SIGN HERE - date ii <br /> I awn of owner or buueing contractor) ( ) � i yA <br /> ZONING ADMINISTRATOR <br /> C <br /> TOWNSHIP PERMITS MAY BE REQUIRED �- <br /> TFSPERMIT$HAL EX�IIE ONE YEAR FROM DATE QBSUTFi/S/m74 14- �S <br /> W <br />