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-r4 I h vaU -q 33 S-0 SI oD <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER P(LV.<L a1 ACA) �EISA TELEPHONkt,S-1) q" L (Oq 7 n <br /> MAILING ADDRESS f J,b� M L°,f[g hf'vL t,,) � cKl/ 0 <br /> PROPERTY ADDRESS W, m/l.l <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) V � 3 &A -Is-YD-1(, 6 4,a,.lX' L1,�„a,c� <br /> r� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE TV ADDITION ❑ uy <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT Lel SU DIVISI N ❑ a <br /> STRUCTUREIADDITIONOSE: 1, m Hint, (fj/(/L� �- PiCi 'rp x 3(p o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> �^ d <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> PLOT PLAN MUST BE PROVIDED LEAST AN 8'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> T <br /> O �• <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p V ` <br /> T a <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 ;? <br /> NORTH(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 0 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2. <br /> F r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o Q <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> P O <br /> CONDITIONS OF PERMIT: f� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT j t <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. /((/���) / p� <br /> 5 \tz> �f PIA� 2PAX1 yT��Al,o A /( lr �/� _ " " r''A A W 0 r- > D O v <br /> 6. � /'P:/1'18�1e_j ori b� �Q¢G /� urj M C W M 8 `�° a F m <br /> v omcN " 05ic <br /> 7. Z c in 'C <br /> 0 1 <br /> 0 i T <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m L q A <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of J' d cn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize . m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i ' <br /> (1 : >- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ® m' <br /> authorized person to have access to the abouwdescribed premises at any reasonable time for the prose of inspection. m <br /> T a : <br /> m D ; <br /> SIGN HERE <br /> e of own r building contractor) (da e) o <br /> ZONING ADMINISTRAVFur <br /> fn er <br /> fA 6i � N <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> r--I?r/Yl i > - -i 4)4 {.s P iC &2d (AI-2 bq KR,,'ln A--ISShf/ g j <br />