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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'n o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> rn o <br /> N /1 <br /> C \, <br /> OWNER ZEe Kir-\zAGL an,,o /{odr12/ fz;e!e �7gN TELEPHONE I(OJ- /SS- �07vJ O <br /> m <br /> MAILING ADDRESS 1�2yg 9'l yc/t <br /> PROPERTY ADDRESS a8S<p LDA/G GAec" (/(// <br /> r-, <br /> LEGAL DESCRIPTION(see tax receipt) 3,04 51A/ fix( See 6 �by 1441 m <br /> DWELLING/BUILDING ISI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ an O <br /> TYPE OF PERMIT(S): iT <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N (� <br /> STRUCTURE/ADDITION USE: �GYYIF r <br /> jk;Y (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) mIQ <br /> f14 <br /> BUILDING CONTRACTOR: hd pA/Lk w <br /> � � Q <br /> CD ?Y� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o _, <br /> n L!' <br /> T Z 3 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). (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. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. I PJI 1 <br /> 5. <br /> X oo0r- > onov <br /> 6. F 3 n M a m p <br /> omcy <br /> Z c '^ m o o -� <br /> 7. m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — o i A <br /> PP ( 9 Y ) Y Y : G) -4 , <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' � C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn <br /> sue a permit. I further accept all liability which may be a result of the County of Buffii <br /> in on th' 'n am w o <br /> providing in this application. I agree to permit county officials charged with adm rerauthorized person to have access to the above described premises at any reaso o f ti ° o <br /> T <br /> ._. I m Da <br /> SIGN HER - —/ <br /> (signat of ow er or building contractor) A( <br /> ZONING ADMINISTRATOR r OCTtr 1 <br /> BURN d�� r�N <br /> ` ONCn W W NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE G <br />