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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator @ Z <br /> APPLICATION FOR LAND USE PERMITS _ <br /> 0 <br /> 65-1-731—/726 C ) <br /> OWNER J16115 Lc/Spv1TELEPHONE <br /> 6S/-�? �-r7��1 <br /> MAILINGADDRESS <br /> l.'i' C O©C1(JfirL rt S-'/2 r— 0f <br /> PROPERTYADDRESS �b �b ROOt,t� La�t ,p <br /> /`4 POhC� �Isc <br /> 1 <br /> M� 7r —63 s-7 t.r � <br /> LEGAL DESCRIPTION(see tax receipt) 63To0 <br /> _ -Tc&-/v Si4frya -i'V 0 AoT3CSA7V2N//7 <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE 11 ADDITION <br /> TYPE OF PERMIT(S): Cn o' <br /> C � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> r� <br /> STRUCTURE/ADDITION USE: <br /> f o <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) m <br /> D j <br /> BUILDING CONTRACTOR: Q r r�t.� /�,4Soh nd-,tie a,S R. I <br /> CD <br /> � � 1 <br /> C <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 3 <br /> O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING.• (AERIAL OR TOP VIEW) A <br /> O an <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n A <br /> NORTH(N). <br /> m <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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. `f I Z <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. <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 /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> CONDITIONS OF PERMIT: 1#-.0 <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT () I <br /> 2. ISSUANCE. SHORELINE. �J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIF <br /> REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG <br /> PERMITTED. r <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHW j� I <br /> SETBACK AREA. S <br /> 5. �I <br /> 6. 5�` 2 n 2004 <br /> P WW ; oDo <br /> �� nyn � A <br /> 7. 3URNETT COUNTYo � y : o 3 <br /> Z C Vl O = 2 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o p <br /> = tn : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m u : S <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- - to <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 o <br /> providing in this a 'cation. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person o ve access to th above deAlLftd premises at any reasonable time for the purpose of inspection. <br /> -n a : <br /> SIGN HERE 8�8 O m� a <br /> CL <br /> (sire of o ner or building contractor) ii <br /> I , i <br /> ZONING ADMINISTRATOR V I <br /> tA <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N W <br /> SEP t 2(101# 0 <br /> THIS PERMIT SHALL EXPIRE ONE Y AR FRO DATE OF i$ ANCE o`�o7af !� <br /> � )Qr l tOl � 1�. '70is pis o.l /l!'7-d� BURNETT COUNTY <br />