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Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872 Office of Zoning Administrator -V0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> -' 0 Ci <br /> OWNER �¢ GK R m 4t'4Q rib—t, '�o 4--t TELEPHONE �07_ <br /> MAILING ADDRESS 0&7 <br /> PROPERTY ADDRESS /_ g37�L6Za6-e, �r �qa 21nru �� 15 � d Gj <br /> o3Z.5.1�5 05- 3-S( <br /> LEGAL DESCRIPTION(see tax receipt) pAt.-PeG3u ":5 �0� �r,�, 1 X 1 tat u� � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION�11 0 (> <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNITn <br /> ❑ S BDIVISION ❑ � <br /> �q L/- N <br /> STRUCTURE/ADDITIONUSE: L�pkYr1A/ � /T/L� 0 � <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) Cl) <br /> 1 RLo� <br /> BUILDING CONTRACTOR: $�{rr'� �+ C'CJ 6W, � /�/ L f`i-ad <br /> w ' <br /> � n 1 <br /> � JJ <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. m -' <br /> O ^ <br /> / <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 (D <br /> O `m <br /> T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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. C -Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO y_ O <br /> BUILDINGS,ROADS, LAKE, LOT LINES. (,b <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED FILLED. 1 W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, oo �� Q�, ETC., THE PLANS 0 A) <br /> MUST BE SIGNED AND DATED BY THE OWNER. /(J � / LJ 0 r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI1 TIO �� �IEa h/j1 W <br /> NEEDED. <br /> Oct <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ` ` �j: Z <br /> CONDITIONS OF PERMIT: B(JAN� '�f/ / o4� <br /> 1 <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT,>Or 'ACOU, ) LA i t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,11�,V �Y ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (x ` <br /> PERMITTED. `^Jf <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> m m rcDi � 25. <br /> 7. <br /> �]� 1 (.� c�lU �p 3 0. � xn <br /> fD C j, y _ <br /> 7. 0 <br /> O Z N nl O 10 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of mc`� <br /> v, C <br /> �' a 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �: m O : 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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to haverqccess to the above described premises at any reasonable time for the purpose of inspection. fD o <br /> CD <br /> SIGN HEREft <br /> (signatu owner or building co tractor) (date)J <br /> ZONING ADMINISTRATOR <br /> • EA 69 EA� fA�N/f� il I NNNN O <br /> / IAVI <br /> TOWNSHIP PERMITS MAY BE REQUIRED NO(T (n O i <br /> mailed , Pew; C4-r)&-7L- 16 -1k -03 <br />