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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER ✓JO/J�C'/� tc Lae Al >7d pse,7 TELEPHONE 6,Sb-33 /,S o <br /> MAILING ADDRESS V6{,ei lid D64a ` g I�v� 3ya30 0 0 <br /> PROPERTY ADDRESS 3Q�005> as 61kVe 1 <br /> ,27- J& 4027 ,YH 2-y -/ -27-3 r i <br /> LEGAL DESCRIPTION(see tax receipt) 1 <br /> S 7-#/ ' c 6 -YO/I A/ S i n <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE K ADDITION ❑ O (n ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ `� a �` <br /> // / N <br /> STRUCTURE/ADDITION USE: �IL[CI7//7F .JhBOl ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> m <br /> BUILDING CONTRACTOR: d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p = <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m .° <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. a <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0bi <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro <br /> o � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN = o <br /> NEEDED. ( i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, Z N <br /> 0 <br /> CONDITIONS OF PERMIT: J <br /> /I I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 ^1 <br /> ISSUANCE. v" <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <br /> 5 InaLchl mss c�i D bf, kstd fi r ova re s�c�+��l�arr��/S�a�a�a en�y- <br /> N D l ft) Cn- L4cSC/� �l� x1 m n r D 0 D 0 M <br /> h((r� Qh h� t�fxh0✓�_ MNd ° � afm <br /> ° > ° ° ate <br /> 6. m �c o a m x ,- ;u <br /> EMC: ^ o53 <br /> 7. <br /> ° m T A <br /> - a ; On <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP ( 9 Y ) Y Y L7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <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 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 County of Burnett relying on this information 1 am m o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m 'n <br /> m <br /> SIGN HERE :�UJI6 O6 d+ n <br /> (signature of owner orr� /buil�dingg cconntractor) (date) 0 <br /> ZONING ADMINISTRATOR a6) FIli{.r ! t✓ i2n <br /> O�fA fR fA EA�N <br /> O N Ut W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIREDTHIS PERMIT DATE OF4� �{ Q o n o u o <br /> �✓�/���C'L I�Pi�E/�ELE fC7 ML-uc /q-mr) h lb- //7 -�� <br />