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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 @Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> OWNER TELEPHONE <br /> O' <br /> MAILINGADDRESS ( '��- mel ,y/)q�� �j�rj L��� �s� O <br /> PROPERTY ADDRESS �(QLf LACa W\tQ> L.G'f.ylb u" (v( O�0 . <br /> ScC zo oah o 1Lr16 <br /> LEGAL DESCRIPTION(see tax receipt) { — "Jake, <br /> DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION 'Ile Y1 ' to o J <br /> TYPE OF PERMIT(S): X, G_n c ' <br /> FILLING/GRADING CMPING UNIT ❑ SUBDIVISION ❑ 7"' ` a <br /> h r t C n w <br /> STRUCTURE/ADDITION USE: �� I! �'e w I I 1 h (' , <br /> ! (Home/Cabin; Commercial usiness; Bedroom; Deck; etc.) n Q <br /> lrCUL_'V� Cy W , _e_w e� <br /> BUILDING CONTRACTOR: t't'` t <br /> m T <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> ;0 N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OIn <br /> m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 'F <br /> NORTH(N). <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 I z <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 X� <br /> BUILDINGS, ROADS, LAKE, LOT LINES. I .� <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 P o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> Oo <br /> � <br /> Ore <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> 2, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �' J <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT _ i <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ujj <br /> 3 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATERSETBJ <br /> 5. �DACK. pS p�I�CtV5 61' pa}-iazS Oh -Yhfs ptrMj'4 <br /> �(GI <br /> A O r D O D O m <br /> m c m n m a f m <br /> 6. m F 3. 3 nm xa' � A <br /> a <br /> 0mcy !' 003 <br /> 7. Z m m o <br /> .'O <br /> = n : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best m <br /> of my ; cj C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of [ m <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 by the County of Burnett Wisconsin in determining whether to is- rz: <br /> G1 : <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this informationIam m : o' <br /> providing in this application. I agree to ermit county officials charged with administering county ordinances or other d m' <br /> authorized pers to hav access thea ve described premises at any reasonable time for the puToy of inspection. i i i m : [ <br /> T <br /> m <br /> Di <br /> SIGN HERE 7 0 6 w <br /> (signature of owner or building contractor) tlate oo`` : o <br /> �� contractor) (dateN [ i <br /> ZONING ADMINISTRATOR \T m Flan n ` . <br /> C ON N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED C c, u u, O <br /> P <br /> THIS Z MIT SHALL EXPIRE ONF YEAR FROM DATE ISSUANC <br /> C(nd le- WIC P10 ted k by fCVen �n;Li� -a�-06 <br />