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�o <br /> Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _ o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> N <br /> OWNER `,(ry �. G )7/7 TELEPHONE J/ 2 <br /> T � a <br /> MAILING ADDRESS ' ITd! Y' rG n <br /> PROPERTY ADDRESS /Z/ Sf �� �� G yfti/�5 �Ur r <br /> 0 <br /> LEGAL DESCRIPTION(see tax receipt) P61 /�lY/NW d Sul NWi S/lol T3z R/RV✓ 2 D /�c r e 5 S� c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ y a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; beck; etc.) vI <br /> { , <br /> f W <br /> BUILDING CONTRACTOR: j e/ uy <br /> w <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. m0 <br /> 31 N <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. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn Is <br /> NORTH(N). Co <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. 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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V 1QA7/� N ONE WHEN o <br /> NEEDED. �/ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: I APP , ' o CIa <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS f �ly�T <br /> ISSUANCE. CO / ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR O(J q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY/NG AY C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. !� � [ lW / <br /> 5. 0 v c -5 �(J - <br /> 6. e �yQ��j' 77 m. 3 n m x a m <br /> M <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 �C E <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ID " ( m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- +_n1 <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 ro <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to he above described premises at any reasonable time for the purpose of inspection. m o <br /> L' / C D <br /> SIGN HERE '7 - <br /> (signature of owner orb Idinng contractor) (date) ` a <br /> ZONING AQMJN'I`STRATOR W i"IC 6 E <br /> �—tv fAfA EA EA N <br /> ro (NO OTOWNSHIP PERMITS MAY BE REQUIRED r ;,.M ;. II <br /> ��THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE `er <br />