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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator Gp,�iN ° <br /> APPLICATION FOR LAND USE PERMITS <br /> ON Cp � <br /> a, 1 4-- <br /> n� <br /> OWNER �.i-e J e I ` \ (l Q,. TELEPHONE 9507- 307 -3 0 3 0 <br /> }} O <br /> MAILING ADDRESS a LpQO �oQet- �r.✓2 Agke- tJ41 6 ' <br /> PROPERTY ADDRESS a-7/7/S-7 LtJ =V84 S <br /> Sec,3s S/O/� �Co Lt1 GdV. <br /> -7 <br /> LEGAL <br /> d <br /> LEGAL DESCRIPTION(see tax receipt) („a+ (p v / '7 39. <br /> m <br /> DWELLING/BUILDING 9 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): 4 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> y <br /> o.•-It Garb%-� ° ` <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.)��v e W <br /> 1_L L ��p�p t� +< es ;;l6 E qsa-,V,2 I <br /> BUILDING CONTRACTOR: F/-r r�raa �r r ,z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 -F N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Ma <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I o <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 O <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q Iv G <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 01. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ge <br /> v f � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> z O O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. OCA <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 0i <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. mm ? CL <br /> n <br /> m 3nm <br /> 6. Z y W o <br /> 7. "` On <br /> —� ' 0 <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 a y <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize p� m $ <br /> P ( 9 Y ) D <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Q ? t <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or oth4c m cn <br /> authorized person to have access to the above described premises at any reasonable ti -n o : <br /> C <br /> SIGN HERE /I ° `• <br /> ( sture of owner or building contractor) 1 date) <br /> rn �1 3Ea 12004 € <br /> ZONING ADMINISTRATOR d+ <br /> °3URNETT COUNTY v ono o <br /> TOWNSHIP PERMITS MAY BE REQUIRED W'o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCJQNING U) 11�1 <br />