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Burnett County 7410 Co. Rd.K, No. 102, Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> UT O <br /> d <br /> OWNER N �ti���ury TELEPHONE q ,2,-a2Z-k � = G <br /> d <br /> MAILINGADDRESS �y25 CsI,�N6RTZR�(�P� EpINRI Al n? LSHIU f <br /> r <br /> 0 <br /> PROPERTYADDRESS 14 g1(1 Bt' RpM gyp . (,yt✓- JTC12110 ( 94993 <br /> o ` <br /> LEGAL DESCRIPTION(see tax receipt)2-01 A-S 'jbgl&.z3 -RoGe'sAPv,Vr8 <br /> DWELLINGIBUILDINGI GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ O' <br /> TYPE OF PERMIT(S): r " or ' <br /> I C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: CW&U R nits G-ArZ OGr w <br /> o' <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) (n <br /> v <br /> BUILDING CONTRACTOR: M AKV I AI RA*6& 34 lp -Xb 7-1 <br /> m <br /> Z � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T V\ (�` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 R A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 13 <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. <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 1 <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. U3o <br /> o <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 ) <br /> CONDITIONS OF PERMIT: 1 C�+ <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. (113 1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> Llfqo'lQ ,Q�f /y ��E�Y2f <br /> 5. O 7CJ V —(J� C/ <br /> n m x n � <br /> 6. @ 3 <br /> -am Cy ° o 3 <br /> 7. Z y o <br /> W . M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d d, <br /> o. - : � : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize � m o : M <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- ^r� m <br /> P 9 P Y tY 9 �L7i O: <br /> sue a permit. I further accept all liability which may be a result of theCoun of Burnett relying on this information I am m : <br /> providing in this application. I agree to permit county officials1 �"g county ordinances or other <br /> � <br /> authorized person to have access to the above described premis for the purpose of Inspection. m o <br /> th <br /> SCD <br /> CD 3 <br /> IGN HERE f^ �� k A �+ �_--ic AI If! � ' `v"-1 <br /> CL : <br /> (si ure oviner or buil ' c ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N N O <br /> TOWNSHIP PERMITS MAY BE Rei2U[RED <br />