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Burnett County 7410 Co.Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER E /r--17fA-jl)t)t,;,-WTELEPHONE 2l( 2 '7/27 <br /> N <br /> 1 <br /> MAILINGADDRESS <br /> PROPERTY ADDRESS �� �� , C �` �R ��Y IIA/ \ ^� <br /> LEGAL DESCRIPTION(see tax receipt) N�f , �tii (� U Greek W 1 }C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION U) <br /> TYPE OF PERMIT(S): V1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> Sung )Oo,G� /y `Y/G ' �j <br /> STRUCTURE/ADDITION USE: °� <br /> (Home/Cabin; CommeEr-661 Business; Bedroom; Deck; etc.) Q) <br /> BUILDING CONTRACTOR: �� m <br /> c .R <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p _ <br /> M N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n o (4 <br /> T 7� <br /> n O 1 ` 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 m 'T- <br /> NORTH <br /> NORTH(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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. f t <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o ( _ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT T /^ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C/ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. <br /> SETBACK <br /> E S l hG^ 0A O" �I <br /> (7 aI Or DODOM <br /> n <br /> n O a F m <br /> 3 <br /> 6. m �cam x � � � <br /> 0 0 cy o 3 <br /> Z c v, -� <br /> 7. oo m it's . A <br /> _ U) ; m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m p <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 of <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognizem c m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° (n <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 administering county ordinances or other <br /> authorized Rerson to have access to the above d scribed premises at any reaso a i -cNn. ° n <br /> -n N D : <br /> SIGN HERE °a- <br /> si n to of ow building contractor) date) p , <br /> ZONING ADS INISTRATO! JUN 2 7 2005 <br /> En: ifl <br /> �d9 b9 b'i N <br /> TOWNSHIP PERMITS MAY BE REQUIREDBURNETT COUNTY <br /> THIS P MIT SHALL EXPIREONE YEAR.FROM DATE O ISS LIG c, <br /> trrn <br />