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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 /> s <br /> OWNER tav' S '� t l l TELEPHONE q LS--&63- 3353 0 J <br /> m <br /> m <br /> MAILINGADDRESS ?;3-?0 v\ UE Zech-ez�c u; _ `J, . FO <br /> r m <br /> 0 <br /> PROPERTY ADDRESS (.�� 'fdT7', k3 tc, 6 1 <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) '-- <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ° <br /> TYPE OF PERMIT(S): i <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ /1 n <br /> STRUCTURE/ADDITION USE: l'VIL!n, Ct a ll ° <br /> ( ome/Cabi Commercial Business; Bedroom; ck; etc.) m <br /> BUILDING CONTRACTOR: m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/X 11 SHEET OF PAPER. ANY INCOMPLETE OR r 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> ;0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) - n <br /> ?t O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH( ) C0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> a <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. P <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 ( <br /> o � nn 11 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Y <br /> NEEDED. 2 R.! <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 6 <br /> ISSUANCE. r' ' <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. rb O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 0 <br /> SETBACK AREA. <br /> 5. <br /> n o > O � <br /> 6. m x3 nm F �' r= A <br /> om Cm .`^ o53 <br /> C N N <br /> T O O (O <br /> O N Tom ' m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — r^ O <br /> PP ( 9 Y ) Y Y G) C J ; C: <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize ' E m C no <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J 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 d o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r a <br /> m D : <br /> SIGN HERE <br /> (sir n ure of owner or building contractor) (date) 93 <br /> ` <br /> �y� 104 <br /> /� ��y (JCnJ <br /> ZONING ADMINISTRATOR ' t ✓ F`0 <br /> -W'jar)Iyt�n �'I ' i i <br /> ONr-� �fA fA fA EA�N <br /> V O (I� OrT U� rI, O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERJMIT SHALL EXPIREONE Y AR FR M DA E OF ISSUAN <br /> Perm 14 4 le+�e�100CW up gtl i � I N 5-�a-b� <br />