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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. U5 <br /> Cell <br /> OWNER (A I r rC 1 4AiL A" T A,,rr 1, WLFj�nCLEPHONE f/4j—.f <br /> r 1 w O <br /> MAILINGADDRESS ��. �n 44Z F"JetiC. wrs <br /> PROPERTYADDRESS rL ng(03 F )ejoJ�50� � � �Qn�,Tsb5--�7p 00 <br /> 1 0 <br /> ( p) )'vr / Cs�1 dB P M Z r� <br /> LEGAL DESCRIPTION see tax receipt) ry� �. <br /> V m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 100,M-ft �.f$TOQ R-�£ 6 93 <br /> (Home/Cab* , Commercial Business; Bedroom; Deck; etc.) W <br /> g <br /> BUILDING CONTRACTOR: �2TTS �y�h NGk;�1-g �+ &*A.A5fR .C.Lfr1�A7 C'T&Llt/+/�!/�) <br /> v � <br /> m <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. T <br /> M •�J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n � � ZA <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m r" \ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF - COZ <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. C <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 W <br /> MUST BE SIGNED AND DATED BY THE OWNER. ` 0 o <br /> NOTE: BUILDING/STjtUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » <br /> NEEDED. <br /> \ �1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT rrC11`` <br /> ISSUANCE. W <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. \ O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. �r�/`]//�J - nnf fog hctw, ha6 -/-&h . <br /> V m o0i ori n <br /> 6 M a : m <br /> . n <br /> Ei x�3 C: 0 Fam .L <br /> a pmCy .`^ o53 <br /> 7. Z co 1 <br /> T� 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 <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- <br /> sue a permit. 1 further accept all liability which may be a result of the Count of Burnett relying on this information I am d o <br /> P P Y Y Y Y 9 �' <br /> providing in this application. I agree to permit county officials charged with admini r' o ippn as or other <br /> authorized person to have access tot above de ribed premises at any reasonabl4 a e� m <br /> r n <br /> Di <br /> SIGN HERE r G n <br /> (signatur f owner or buildipg contractor) dept ry ; E <br /> On <br /> AU <br /> OG V L006 �n <br /> ZONING ADMINISTRATOR DL l `! I <br /> CONN (JNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERM T SH LLE PIRE ONE YEgR FRO DA OF 1 AN NING <br /> 7R7�mT� (��-� je.r fy,\6 l e)9 lU .41 W f r7 h g-30-66 <br />