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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. �- f ` <br /> r �L <br /> y O <br /> OWNER J <br /> N <br /> 1 d Vr�1 '/k <br /> h I ) h , 1 TELEPHONE -7/ o <br /> MAILINGADDRESS (� p jax G.� S1re0 O <br /> PROPERTYADDRESS 2 -711F-1 �a5"l �eJ LIS hA1�. (Q� W' LjS�Ct,- W LS Sy�93 �o <br /> Go S 9,ro+II Ca i(�s 75d 1.0 � moi" 3 ,/ C' <br /> y � <br /> LEGAL DESCRIPTION(see tax receipt) �vi�s �� �dl(�nnA Iy,�S ��✓t,�s,-I' �e Wt( prn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ y <br /> TYPE OF PERMIT(S): cQ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ - n <br /> 9 qe. akC\ lox2K L L , <br /> STRUCTURE/ADDITION USE: �H3�+ AVa c Qr. co,Ca t... <br /> wlng (Hdme/C11abinl; Commercial Business; Bedroom: Deck; etc.) <br /> BUILDING CONTRACTOR: )!o N11# eh gckllz— � <br /> o S <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE ORB <br /> D <br /> (r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> �1 N Cn 4-- <br /> t <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) onbt J^�—w p m l? 0 <br /> n <br /> ,n O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ru A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cp <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 Q�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. O 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Qss1 Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS � t <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o I <br /> 0 t <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » � O <br /> NEEDED. <br /> Q <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. XJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. MwrJTA*l >- 0 seaAcK Fro n S,rt. tissory ark cF.0 a4 NaND f7owrs (Nate: <br /> 6, ow"S4/E ToE /S JUDkTN4lLy1 <br /> r x3 D sam Amy <br /> ¢}CCS ar Si(UC hurt +a be uSPd For �Jrt✓u I2 �zStG, n aI rQ�[lSforct� Dn)t�. 9 o m N N o 5 3_ <br /> C y <br /> " ✓ for <br /> I f C O O <br /> 7. /110-} 'rD useAK forhUMRh �' a&-&j7'op, P <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m D <br /> PP (� 9 Y ) Y y <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy ofw' 2 <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 County of Burnett relying on this Information <br /> V I <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 the abve des bed premises at any reasonable time for the purpose of inspection. ` m <br /> u <br /> n ; <br /> SIGN HERE <br /> (sinatnla'tureMof owner <br /> /}ornbuilding contractor) (date) 0 <br /> ZONING ADMINISTRATORy' t I J �/✓l' /( n �: <br /> Q�fA 63 fA 63�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> do � o � �No <br /> TAS PERMIT SHALL EXPIRE ONE YEAR F OM DA E OF ISSUANC <br />