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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> No 4?Aj qn,) 6a -6 33 c� <br /> OWNER r'l O1V`T�KJM 6�ZIAIA' Al 41-S SO A/ TELEPHONE 71 S`�Q r( G ��i � p �: 9 <br /> MAILING ADDRESS d':q.55 LA7 a Q--k IV/ ISO/v tP b J'T O <br /> , 511 30 <br /> f��121/ d� S � <br /> PROPERTYADDRESS <br /> 1o71. C SM V 1'7 PIS i<f9 )W Goi+T I-oT3 SECTa3 7awA�hlpyb A/6, <br /> LEGAL DESCRIPTION(see tax receipt) RAIU& E l4, to E57- 8 u"ETT 12-Ty ed- m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREX ADDITION ❑ fn <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: n- <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: M 1 P�I7 4 FL f'�'7 �/vt4/✓ <br /> v <br /> J <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. /�N C) Ip rJ� /I/f 0 N J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) V 1 rJ '1C� llC.-l..Li O a <br /> r <br /> r o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m f�`�r`,^, p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m `° W O <br /> NORTH(N). Cl) <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 CJ 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 ` <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 OO 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. =\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o .(,tel 0 W <br /> CONDITIONS OF PERMIT: (� r0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. C O O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY / O <br /> PERMITTED. �1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m d 0 0 D O V <br /> 6. m D3nm OaT. 3 <br /> Z 07. : 0N �''o -f <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — 0 <br /> PP ( 9 Y ) Y Y Kl i1 v : 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 - I: m c m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G>t <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am d o <br /> providing in tl}i� application.^I agree to permit county officials charged with administering county ordinances or other <br /> authorized pe s to hav,41aicolitss to the above described premises at any reasonable time for the purpose of inspection. a <br /> T <br /> D <br /> SIGN HERE tl VL. ) 5 w E ii <br /> (sign a of o or building contractor) (date) ' o <br /> h r <br /> ZONING ADMINISTRAT i MO n � <br /> TOWNSHIP PERMITS MAY BE REQUIRED �l <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FRO DATE OF I UANC <br /> �P�mi�- � ISI fern �"eA Vo <br />