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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrato - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> CD <br /> N <br /> OWNER TELEPHONE QlUO <br /> m_ <br /> MAILINGADDRESS 'x/007 e e��r <br /> m <br /> PROPERTYADDRESt"') U clI?Y F-13 /yam <br /> LEGAL DESCRIPTION(see tax receipt) /Pq„ t 4 t GDvf[6-17 157-3F/V 45� <br /> CD <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ TION c 0 <br /> TYPE OF PERMIT(S): yP(I /`Jp hx LLA <br /> FILLING/GRAD NG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ r ^ `` l V`" e a <br /> STRUCTURE/ADDITION USE: O r12 e d ro a nti f3a,{ 9� r�, eon <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: �/ /Y GUC E l ak% Ter N (G 11t e 9 n <br /> CD <br /> C�+1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> �J <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 O6 <br /> O <br /> �1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CD 1 <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ED <br /> NORTH(N). C 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 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 02. I <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> -/ v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI 7 NE WHEN n o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. l ��/ ` ` o <br /> 40�� <br /> CONDITIONS OF PERMIT: S ' <br /> vvv I' ` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE k, .r <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �C <br /> 3 NO GRADING Z <br /> OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O �N� <br /> PERMITTED. �y (/N <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X <br /> Ori > 0aD0 -0 <br /> 6. m3 nm yam <br /> m <br /> 7. C N ^ o 3 <br /> Z N O <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 obi vi C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize CD o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 m <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 above described premises at any reasonable time for the purpose of inspection. ID <br /> T o <br /> CD m : <br /> SIGN HERE <br /> (signature of owner ildi ont - a <br /> (dA <br /> to) <br /> ZONING ADMINISTRATOR 2/ 6Z1- <br /> ' fA EA fA fA � N <br /> TOWNS IP PERMITS MAY BE REQUIRED T <br /> 1a90 s <br />