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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> OWNER JO i'1 n GLL "�4 1"$O/v TELEPHONE <br /> 77a9 m ) <br /> MAILINGADDRESS �� 5/rf� C'C✓l5 cd { �� �g��� v <br /> PROPERTY ADDRESS /0 fs` /1 i15 SCA-.�� ,4G✓.0 �j,¢SS J-4/ 4e "'90A'21 ( o <br /> LEGAL DESCRIPTION(see tax receipt) -f�l/ 115`5S.[4/!e- ffL✓P$ Sig>` v/ /1"1" <br /> J� <br /> 0 4 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ N <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: 4Z 4., EA nL h QuSc— 0 �- <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: S'G <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 Q <br /> J <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p c� <br /> T n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T 0 p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N ^ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m (If B <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. 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a Q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o vl S <br /> CONDITIONS OF PERMIT: <br /> 1 ^ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. r^v G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V 1 C) <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY f n <br /> PERMITTED. VA <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m c° , MnM ajm <br /> n� 3aoono <br /> m c <br /> pmC , ^ og3 <br /> 7. <br /> 0 m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my - �' 0 <br /> PP , 9 Y ) Y c , C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of � <br /> all information contained in this application (Including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D cn 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 <br /> providing in this application. I agree to per it county officials charged with administering county ordinances or other �': '• ` d �° <br /> authorized ave acce s to the ab a described premises at any reasonable time for the purpose of Inspection. ' m <br /> U :: <br /> D : <br /> SIGN HERE <br /> s, atgre of ow7 or ildiRq contractor) (date) ' o <br /> ?r�� l �� <br /> ZONING ADMINI TOR <br /> `� ON (Wl, N <br /> TOWNSHIP PERMITS MAY BE REQUIRED /Vy OUU,, 0 <br /> THIS PERMIT SHAL EXPIRE QNE YEAR FROM DAT OF ISS U�1 CE <br /> ((f11 cr u.p � 4 �hrn <br />