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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> w o C7^I+( o <br /> OWNER 1 1 �l K ISSA er o Vv <br /> TELEPHONE <br /> 1 C[r� d J <br /> o <br /> MAILINGADDRESS 13 98 2 Wlncre4 ,,41 N <br /> �!I r <br /> o <br /> PROPERTYADDRESS `�,30 CIQNNUfS �IC1r� IL`�J� I <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) I , 3 SeL, ! /(/ (Q KJ m <br /> 1 ^ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o <br /> TYPE OF PERMIT(S): <br /> n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S/UBDIVIS'IO'NEl <br /> `, - l /� <br /> STRUCTURE/ADDITION USE: 14mgL OI,r yO r )�CN 4'/ /a t yy <br /> V l <br /> s� (Home Cabin; Commercial Business; Bedroom; Deck, etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 Ln <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. / Cp, fN�• /an. �73�71 O — G <br /> l\ / A C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> ?I O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m —T o <br /> NORTH(N). 3 <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 t 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 O <br /> BUILDINGS,ROADS, LAKE, LOT LINES. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 't N C <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. <br /> 7 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. ZA1U) <br /> AZA <br /> THIS PERMIIS SUBJECT TO ALL CONDITIONS LISTED BELOW. / <br /> CONDITIONS OF PERMIT:1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'Zo <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 3J G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m co ori � n � M <br /> o � 3nm <br /> 6. z 0N � oN ?� a,� <br /> 7. P m iz'z X1 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my [ G1 c ; O <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 1 further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1 O ! s <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 ` : '; ? o <br /> providing in this application. I agree to permit county officials charged with or ther ,o <br /> authorized person. a access to the above described pr ises at ny rea r t r on. ` m <br /> T a <br /> � n <br /> SIGN HERE n <br /> g tura ner or buildi g contractor) OCT 2 6 <br /> i <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNc,M W W o <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING o u o u u o <br /> THIS Pf..J�M1T SHALL EI PIf2E ONE YEAR OM DATE\Palm N�E�SrV,(— <br />