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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> OWNER A,l✓�/(//r:L �J O yt-.� TELEPHONEE---,� r'JV'f�c <br /> MAILINGADDRESS G 3Oj �j(.k1yj2/1/� `t/ SIG/C ,/� 7 �)7i v ('10 <br /> PROPERTYADDRESS 3o3 apz 1<b,, �C /�t/Er!�S/✓ � S `14 , <br /> LEGAL DESCRIPTION(see tax receipt) D' J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ C ^ <br /> TYPE OF PERMIT(S): — <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: C.R'2Pe,1ar `; <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ( C7 <br /> BUILDING CONTRACTOR: E��CAt✓ d7—GL'L <br /> 0 <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. �nC _ �j- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Vr Nl b� V` A <br /> O <br /> M <br /> M `A <br /> 7t O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W v U 3 <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. t P <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS Q 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f W <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g p` <br /> NEEDED. " U' <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 C5 <br /> O <br /> ISSUANCE. D C> <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 <br /> SETBACK AREA. <br /> 5. <br /> m 0 nim <br /> 6. m m am Ow M <br /> v pm Cy .`" o � 3 <br /> 7. O ;I <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 G7 c 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 (including any accompanying schedule)and I further declare that I recognize m mo <br /> ` <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- � ` `� ` W : <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 o <br /> providing in this application. I agree to permit county officials charged with administ <br /> authorized person to have access to the above described premises at any reasons t <br /> SIGN HERE ` n <br /> (ei na(ur of owner or buillding contractor) (date�p <br /> ZONING ADMINISTRATOR OCT Z 6 LWS <br /> i <br /> BURNETT COUNTY O N W W N O <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED V O N c>O N N N O <br /> ZONING E _ <br /> v �l <br /> THIS PERMI HALL EXPIRE ONE YEAR FROM�DATE OFJSSUA t, w6ver <br /> Io_31 <br /> �r'm(i--r Z'in <br />