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Burnett County 7410 Co.Rd. K,No.102, Siren,WI 54872 Office of Zoning Administrator - o° Z <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> gQ/OWNER yL r)r� / lqS S-- <br /> d <br /> y` / m O <br /> MAILINGADDRESS // R LP 1 /+�q"jeR s rA. lwacj, fep <br /> PROPERTY ADDRESS �J(� CDurr7� foQ f't �2/✓s7ee `tli, ..�eP93 1 <br /> b� 3C .20-4 a7/73 5'z0Tµo RNWi9ereS 40. 0co <br /> LEGAL DESCRIPTION(see tax receipt) 2_L/0_/q _2Q —( 04 0 0co I ( C?o 5 E NE `ami <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ".•JJ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> T. <br /> STRUCTURE/ADDITION USE: ab/N 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> 2. <br /> BUILDING CONTRACTOR: Y'o 4 -ae- H 6 Q ee S <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'ke X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o °J <br /> 71 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN 70 SCALE. m � jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M3 <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. Dj Q <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 /> 106 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o' <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE BE DONE WHEN q <br /> NEEDED. L JI �. <br /> 77,�J71 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. =I o <br /> CONDITIONS OF PERMIT: AN ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 D S OF PERMI <br /> ISSUANCE. B�JRR((n��+ -��-- _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH -1 ECOUNTY <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICA KING <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M 11 :M)mc09 aFM <br /> 6. m 3 cam x ;w D <br /> Z N m O N p <br /> 7. o T< <br /> -m: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m En <br /> rL cn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o Irty <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 o <br /> m rn <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o , <br /> 01,01 <br /> m m <br /> SIGN HERE <br /> signature of 046n r building cont actor) ate) CL <br /> ZONING ADMINISTRATOR <br /> �a <br /> (A Cn EA N N <br /> N Ot N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED u cn o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a" <br />