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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3. UJ <br /> r Q <br /> ¢rye ,I C -mac- -Zl.s- 86 6 -7ff1p5�/�C� e/ <br /> OWN��L- tU(rp TELEPHONE 30' <br /> 0 <br /> MAILINGADDRESSCD <br /> CD <br /> PROPERTYADDRESS t� �j/ /E?� v 1 ' <br /> LEGAL DESCRIPTION(see tax receipt) - <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Q) 0 q„ <br /> TYPE OF PERMIT(S): Q <br /> FILLING//GRADING El CAMPING UNIT ❑ SUBDIVISION�T� 25. <br /> 'T. R' a n <br /> STRUCTURE/ADDITION USE: 1P1a4 nZ.& /490 &U /y <br /> (Ho Cle C/e am bin; Commercial Business; Bedroom; Deck; etc.) to <br /> m � <br /> BUILDING CONTRACTOR: Eu <br /> v <br /> m r <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOM LETE O � T � -7, � ��/') <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Seo-e C I�nj�M„ O _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) � la { $ I I.SSurO ICI 97 O m <br /> -n a <br /> TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y ' 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 rr ''�' <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 V <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 ° t <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <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: IU p <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. A Q <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. P tCfOr� bC 7 Io r V M ! � Vr'o'Kz a r <br /> /� p y s 0 Ooh DODOM <br /> 6. - A�1lOv tr if 6< le-ss-7k&— 5d 90 e-a/Y^-'O P;r,� At,h'/,/e l/4-4 m x 3 a m x a CD <br /> y `T oEj, 3 <br /> Z c in m o co -i <br /> 7. o <br /> _ C, : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my J c I c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D <br /> d : 0 : <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 o <br /> providing in this ication. I agree to permit county officials charged with administerin co r ' other <br /> authorized per <br /> on <br /> have access the abo d r' d premises at any reaso r u e tion. m n <br /> T <br /> CD <br /> > : <br /> a : <br /> SIGN HERE <br /> ature of owner ing contractor) _(dale <br /> MAY 2 ) o <br /> ZONING ADMINISTRATOR <br /> �./ EA Efl Efl EA N <br /> URNETT COUNTY O N U W W N O <br /> Li U <br /> TOWNSHIP PERMITS MAY BE REQUIR a <br /> G <br /> THIS PERMIT SHALL E PI E ONE YEAR FROM DA E O ISSLl I <br />