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Burnett County 7410 Co. Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator -o 0 Z <br /> APPLICATION FOR LAND USE PERMITS <br /> 41 f� <br /> C ��l <br /> OWNER l FtInn\L/-r.N PrOV!-el les TELEPHONE <br /> MAILINGADDRESS {gyp ZOA ztpi� E�1SLLzo � �l�S• J`��1� 3 <br /> Or m <br /> 0 <br /> PROPERTYADDRESS y`c*�!nct "V.Jebg}ex-, n� v <br /> LEGAL DESCRIPTION(see tax receipt) S ecll ,-, 33 -rw . y o R, (lo LOT S 05 M J C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 1-1ADDITION El U) <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> /\ <br /> STRUCTURE/ADDITION USE: oab-,�. ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ° Q <br /> ; � v <br /> BUILDING CONTRACTOR: 'Ya66 ����>,� d ((S <br /> C <br /> CID <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 �` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O m ' , t U) <br /> W v W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C o <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 ( ° ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O ° <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �» <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (j <br /> CONDITIONS OF PERMIT: 0 <br /> 7K Qj <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 93 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (JJ <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. <br /> 5. <br /> A wOrDODt7 <br /> 6. m x amxaCL m <br /> a 0 m Cy o 3 <br /> Z in m o <br /> 7. o m Tom . m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - 4 : p <br /> pP ( 9 Y ) Y Y 7 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ° V <br /> all information contained in this application (including any accompanying schedule)and I further declare that 1 recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m cn <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on th j, on 1 am n� o <br /> providing in this application. I agree to permit county officials charged with 1 0 1 other fD <br /> authorized person to have access to the above described premises at any rea Isle m s i ction. <br /> T n : <br /> l i m D <br /> SIGN HERE 5 i -��J 'O i _n <br /> (signature of owner or building contractor) n(� �; ren to o` <br /> OCT 1 6 LU <br /> ZONING ADMINISTRATOR <br /> BURNETT , N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> G <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DA T,E OU��it, <br />