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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. f „ <br /> r IN <br /> io a <br /> N /; <br /> C <br /> OWNERTELEPHONE <br /> (J'1 <br /> m <br /> MAILING ADDRESS2Z ('t, r QVVmao ojX Q <br /> D <br /> ^ <br /> h 7 307 <br /> PROPERTY ADORES S�(,(h re Q r C{ V.P C>Q o <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORV STRUCTURE ❑ ADDITION ❑ f.0 t <br /> TYPE OF PERMIT(S): c � <br /> FILLING/GRAD a CAMPING UNIT El SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: CAW <br /> (Home/ bin; Cc mere usin s; Bedroom; Deck; tc.) m <br /> BUILDING CONTRACTOR: _e V, G m , V`"P \ ^ � <br /> TI3A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/r X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. S <br /> w <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p <br /> T G <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> C) 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 n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CAI m �� (�j�0 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( 1y 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o (� <br /> � F <br /> O 0 <br /> NOTE: NGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEED (� � <br /> NEEDED. =I ;E <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 0 <br /> ;v0 � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Z <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 �O <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m c: WM0Ma: m <br /> m x3 am 0, -a <br /> C u y O 53 <br /> T. Z C r], O (O 1 <br /> N T'< m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m d+ : O <br /> PP ( 9 Y 1 Y Y 02 � ; C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : a <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m <br /> that this information 1 am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- <br /> p <br /> sue a permit. I furt ccept all liability which m b result of the County of Burnett relying on this information I am v : o <br /> providing In this plic tion. I a ree to permi un fficials charged with ad ' i er i m I �D <br /> authorized pers n o h a apces to a abo d sc d premises at any reason t s I <br /> T O <br /> SIGN HERE / Vj a ` a <br /> m <br /> (si natucre of tlIyer or building contractor) /tl rU{lo� <br /> ZONING ADMINISTRATOR I (�"� r i an � AUG 4 <br /> �fA 6A fe bf�N <br /> BURNETT COUNTY ONUWWNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED C <br /> HIS PERMIT HALL EXPIRE ONE YEAR FROM DATE OF ISSU &ING <br /> Q (mt � <br /> Le-t NAa.AlLd -b �)-nA� (,Son uc470n <br />