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CD <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS o <br /> „ u �/, TELEPHONE <br /> -115-656- 335'61' /boa o <br /> OWNER RL, TU� 4 S 1k l>!�uk 3fo3-(o�P2 Cell ,0 <br /> �/ L Q Q /4? <br /> MAILINGADDRESS -72 $T NRy�JA� �RnC /lOAJt DV n (,k,L� <br /> It � <br /> PROPERTY ADDRESS 60,4m e, <br /> LEGAL DESCRIPTION(see tax receipt) No YY- N F 11OF J lLT/OA1 7 r • /0 Al' /`r' 0 „F <br /> ® <br /> DWELLING/BUILDING LlGARAGEIACCESSORY STRUCTURE LJADDITION CQ <br /> TYPE OF PERMIT(S): 5 CA <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ T. <br /> o �' <br /> STRUCTURE/ADDITION USE: <br /> (3 tJ PLOO rt— <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m 5 <br /> c � <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. X <br /> O o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> -no Z <br /> n m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ( o <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ry <br /> I BUILDINGS, ROADS, LAKE, LOT LINES. o Q <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 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o <br /> NEEDED. <br /> Z R I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT w �/V) <br /> ISSUANCE. .Q <br /> 2. MOVAL OCUTTING <br /> DIOLRESTRICTED <br /> YLINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> Q <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> cpm d cD m CL M <br /> 5. 0 � 3iimxntD x <br /> 6. Z ° y� oyOS <br /> ry T m <br /> 7. — �» tn: A <br /> I declare that this application (including any accompanying schedule) has been examined me and to the best of my c m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible foorr the detail and accuracy of <br /> m M <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize 0 <br /> 7 � i <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining owhether <br /> hma!onto am o <br /> sue a permit. I further accept all liability which may be a result of the County of B;rnett in r i ces or other W <br /> providing in this application. I agree to permit county officials charge Vie} inspection. <br /> a <br /> authorized person to have access to the above described premises at a t! r p m n <br /> y _� a <br /> SIGN HERE �' ° - o <br /> (sig ature owner or Ing contractor) <br /> AUG 2 <br /> ZONING ADMINISTRATOR BURN G`j N <br /> TOWNSHIP PERMITS MAY BE REQUIRE[7-ONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE /OAF ISSUANCE g ��5 <br />