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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> yO <br /> N ` <br /> OWNER ��Uvo �' h^� �S U n TELEPHONES 3 C3S o <br /> MAILING ADDRESS L( y�y :E <br /> r m <br /> 0 <br /> PROPERTYADDRESS ��� AS 19,6 Ile, I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 6d 6-t <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ElADDITION <br /> TYPE OF PERMIT(S): w <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> Lam <br /> STRUCTURE/ADDITION OSE: <br /> iL//h - entrq wtAg r W <br /> (Home/Cabin;C mmercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: 7/y An )n n w — �e U epl 6Lk L eS o � <br /> iu <br /> Z � <br /> v <br /> m <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. T <br /> O N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m c <br /> n cL <br /> In 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, n 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). <br /> n <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. i 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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE G R FILLED. \ N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER�/I n THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. �IL 777j <br /> h� £ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE IFICATION MAY BE �fFE�FHHH <br /> NEEDED. A LI '( J J <br /> P^ 2 7 �r (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. L Z <br /> CONDITIONS OF PERMIT: BURNS-rT COUNTY <br /> Y <br /> P <br /> (� O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER&?IPNINC,, U/ <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACKAREA. <br /> 6. y <br /> 6. l7ll c� * �/7� M L/� / ^µ 3 n m x ° m <br /> V O'! '! w �.lLQ/ D C y y 3 <br /> 7. Z m o ? 0 1 <br /> m� M <br /> I declare that this application(including any accompanying schedule) has been examine3Ty me and to the best of my cj r^ D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of @ n v, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o 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 /> sue a permit. I further accept all liability which may be a result of the Count of Burnett relying on this information I am m <br /> P P tY Y Y Y 9 �' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person t#have access to thea ove described premises at any reasonable time for the purpose of inspection. m o <br /> SIGN HERE <br /> 1 i i n <br /> Cigna ure�of owner o wilding contractor) (date) � <br /> ZONING ADMINISTRATOR Jim 25ain � E <br /> di fA fA fq�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />