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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' < o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> TELEPHONE 7/S o��1�— z Z�4p n <br /> OWNER ���E/(ML,/ �.Grf�t , (! {�,,,I - <br /> MAILING ADDRESS 8o (�/'7 QI(.Y kb � 71x A() �S070 O <br /> //,,,,�� /' y� �a" / l b m <br /> PROPERTY ADDRESS �-j �cYK 1 . 'dr j)iUry C7 . �/ ' �7rF X30 <br /> LEGAL DESCRIPTION(see tax receipt) I� m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ cn O <br /> TYPE OF PERMIT(S): <br /> n <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONOSE: <br /> #O1216� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck, etc.) m J <br /> BUILDING CONTRACTOR: is e-7 i—� <br /> 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W 0j A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(ES)AND ALL NEW BUILDINGS(NB)AND INDICATE C — o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m i D <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 i <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 On. F <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1° <br /> o � � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN k ° <br /> NEEDED. ^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a C �, <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. wwwooaom <br /> O > > O n a <br /> 6. c: <br /> a O m C . O �+ <br /> Z C in N 00 70 <br /> o m G A <br /> 7. - m <br /> = rn : d,E A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <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- s <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 '. 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other d <br /> m : 0 : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T n <br /> 1 - 3 / - 0 <br /> X (date) <br /> ya a <br /> SIGN HERE�4 - o <br /> I <br /> " sig-na�t-ure f owner or budm <br /> d %contractor) (date) O <br /> J11 ❑ IGn (GiGtr> <br /> ZONING ADMINISTRATOR - <br /> er.n <br /> l! ONO (TU (a0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS( NC��� <br /> T721 <br /> rm 4 e+4-e-- d- ie+►- m�I�Qd tv crn (eUV <br />