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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> F <br /> N <br /> 41 <br /> C <br /> d <br /> OWNER All o_c S �CA VX�'. TELEPHONEL 3-Ir -.>N 03 0 0 - <br /> MAILINGADDRESSn �1J <br /> lqa9 ICdttcX SDOC1r"-rvii-7 -C'/X© r f <br /> 0 <br /> PROPERTY ADDRESS 19 o q S V k fA P, O a ra n o", W-= y qjrOj <br /> W <br /> LEGAL DESCRIPTION(see tax receipt) g _ Lill0 -03 ' CO <br /> M <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ N 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: D L b <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) C <br /> w C <br /> BUILDING CONTRACTOR: a r c��� (� I✓� <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tn d A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;° <br /> NORTH(N). <br /> n <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. g� <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Y <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N oQ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 h <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <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. O <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 /> A Cir- DODO <br /> CD W <br /> 6. 3 n m S M <br /> O N C N N p = 3 <br /> 7. Z y N 0 _ i <br /> O TK <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m Ei 2 c <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 w F» <br /> a ^ : L" <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 m <br /> providing in this application. I agree to permit county oistering county ordinances or other <br /> D E <br /> authorized person to have access t the abo desc ibed time for the purpose of inspection. �" <br /> o : <br /> SIGN HERE `f `^ <br /> K LdO3 <br /> ( gnatur owne 4r building contract ) (date) a <br /> ZONING ADMINISTRATOR <br /> (� fA fA fA fA H N <br /> NOI N N O O <br /> ��rr�� (nONfT00 <br /> TOWNSHIP PERMITS MA %1IRED <br />