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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 /> OWNER yT®d� in � TELEPHONE 3 a �'�6 o a <br /> MAILING ADDRESS a QS� U_U�j ook�` t� r 0�3 <br /> PROPERTYADDRESSof <br /> I� apo l� <br /> % f �a�t i G t r `m 1 u l ?J <br /> LEGAL DESCRIPTIO (see tax receipt) / S ,� l� C <br /> �i✓� 6✓i e A ® Kit c <br /> DWELLING/BUILDING ❑ -GARP4E/ACCASORY STRUCTURE ❑ ADDITION Nr ( 0 <br /> TYPE OF PERMIT(S): s Q n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONS❑ ?� <br /> STRUCTURE/ADDITION USE: 6/,i W P 00 M' Fie / 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; <br /> yetc.) nW <br /> 2. <br /> BUILDING CONTRACTOR: p) 0 <br /> U <br /> m <br /> W <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 <br /> �IO N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. IA m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y9 <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° G-11NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q� <br /> PERMITTED. C5 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER U` <br /> SETBACK AREA. �]� <br /> 5. A�PIICQe+ cSeC.tI�L S"' 4*� Pell'md -4, J,, ,wlI � PIh"✓ <br /> 1 M co W W 0 0 n : m <br /> 6. M x3 aM , a `c m <br /> -6, o� C:WWa 3 <br /> v, � o n 'W -� <br /> 7. Z <br /> N . <br /> W T� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> Ern : �„ O <br /> G) -4 <br /> J€ : <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of v c <br /> CL <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- O <br /> sue a permit. I further accept all liability which may be a result of rnett relying on this information I am W o <br /> providing in this application. I agree to permit county officials cPPGfinances or other j <br /> authorized person to have access to the above described premise i e of inspection. -n a <br /> W n <br /> SIGN HEREa2n 0J— ° <br /> ( ' ture of owner or u"dmg contrac ) 6 [ ate) J' <br /> ZONING ADMINISTRATOR ,69 FQ <br /> `V r�`• <br /> 77n� U•�' i V O N 0 W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIfQEl7`�eeuuAA''G C o u o v u u o <br /> THIS PERMIT HALL JEXPIRE ONE YEAAAJ2 FROM F I SUANCE <br /> C -I- '4 me jr ('lame %0--iA/nS4fUdWr 6-8-60 <br />