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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 ci Z <br /> APPLICATION FOR LAND USE PERMITS (D <br /> r <br /> y O <br /> C <br /> N <br /> OWNER �/ dco) S� �� TELEPHONE CJO <br /> L � W <br /> to (° er by Ads Mt%,, �55 411d <br /> MAILING ADDRESS f <br /> r ED <br /> 3! 050 Noble ties Qr. <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTIONsee tax receipt) <br /> ( =Of /� , /1/06�e pS C A <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION N C <br /> TYPE OF PERMIT(S): V VI Q � <br /> FILLING/GRADING ❑ CAMPING UNIT SUB IVISION <br /> r � <br /> STRUCTURE/ADDITIONUSE: OCA 1�� 00 3 Q/ 5 ^ <br /> (Home/Cabin; Commercial Busine s; Bedroom; eck; c.) rn CA <br /> v <br /> BUILDING CONTRACTOR: ; <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 "4Z tI <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Alo_ p– fie'+, _/� X C> O y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T C� ` l/fto�–� `� 444 <br /> / O a <br /> Bim"' f " <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 9�' M z <br /> 0 O � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m AS <br /> NORTH(N). <br /> n <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. 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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> F <br /> v <br /> NOTE: BUILDING/STRUCTURE 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 /> 0 <br /> CONDITIONS OF PERMIT: 7t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> SETBACK AREA. <br /> 5. <br /> 6. m mW y0 �avM <br /> CD x3 nm Ox <br /> 0 m c N o 3 <br /> 7. Z C m CD 0 O <br /> An <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m C <br /> PP (� 9 Y ) Y Y J <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d �_ �^ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize cxi Q m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m : rn <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am ` v o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have a ess to the above described premises at any reasonable time for the purpose of inspection. m <br /> -nCD a : <br /> s m D : <br /> SIGN HERE �55yyY\ Q � es n <br /> (s' a re o�o uilding contractor) (date) - i P <br /> ZONING ADMINISTRATOR <br /> 9 fA fA -+ N <br /> O NON W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o, O v o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANC <br /> -M-0-)�4-'QI e--- y i mk, Led -)a I,� t l 'a n-, a bis 8-2;0 <br />