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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0G) z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> UT 0 <br /> N <br /> OWNER DA✓9F 6 6W-A TELEPHONE �S G�!o—�j a <br /> MAILINGADDRESS <br /> y r <br /> PROPERTYADDRESS 7Al1t <br /> t <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION (n <br /> TYPE OF PERMIT(S): c � <br /> FILLING/GRADING ❑ C%MPING UNIT ❑ SUBDIVISION ❑ —tea. <br /> STRUCTURE/ADDITION USE: O E CAS'; o <br /> ( opmee//Cabin;Commercial Business;Bedroom; Deck;etc.) C/) ., <br /> \BUILDING CONTRACTOR: `G + F��/ O N!�/✓�� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LE T AN 8'/:X 11 SHEET OF PAPER. AN COM-P�/ETE R 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q i)S tfi" +15A `o S�[�j�J �� -n <br /> U O <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> ✓)5 5ai p Q <br /> r z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTAN�ES TO BE SHOWN OR DRAWN TO SCALE. n 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL XISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOL OWING: (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 <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. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS P ANNED 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 I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. S <br /> � o <br /> ��,yy q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION r�1- E � �`� n 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS]LISTED BELOW. SEP O "h <br /> 0 <br /> CONDITIONS OF PERMIT: - 5 2002 ' <br /> t <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT BURNET7r CpUN � ' r <br /> 2. REMOVAL OR CUTTING OF TREES AND V GETATION IS RESTRICTED ALONG SHORELINE. ZONING r <br /> `1 �,' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I� t <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. I,, m W' 'Ong m <br /> 3 am sam <br /> 7. Z N N O y <br /> O A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ( �� cj A <br /> knowledge and belief it is true, correct and co V <br /> 9 plate. I acknowledge that 1 am responsible for the detail and accuracy of m c0i <n C <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- ctm t7 <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perxaa4 have access to the above escribed premises at any reasonable time for the purpose of inspection. m <br /> T <br /> 0 : <br /> CD <br /> �S-ZQd 2-�Qd - <br /> SIGN HE E � <br /> a : <br /> (s nat a of r building contractor) (date) <br /> ZONING ADMINISTRATOR Q <br /> to v, <br /> fA EA 69M -. N <br /> N <br /> 0 Vt O <br /> N N 0 0 <br /> CTO (TO <br /> TOWNSHIP PERMITS MAY BE REQUIRED t � <br />