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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 /> r <br /> y o <br /> N � <br /> C f <br /> OWNER TELEPHONE -7/6-,;1 Qd -- F'74.2� n <br /> W J <br /> MAILINGADDRESS T019Catkmich&.l kD*25/ 14ud- ri t ui30 <br /> S�fdlly <br /> PROPERTYADDRESS ` .. <br /> �L3S0 Cn� H QD N SPooneK W- -1) q / � <br /> LEGAL DESCRIPTION(see tax receipt) ) m <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION 0 \ <br /> TYPE OF PERMIT(S): / n <br /> o <br /> FILLING/GRADING 1:1CAMPINGUNIT ElSUBDIVISION ❑ /i��� lJl�"V�m <br /> STRUCTURE/ADDITION USE: 140M C/ 4 b ih7�CK Fj c�fLoam 111 <br /> (Home/Ca in; Commercial Business; Bedroom; Deck; etc.) W �r , <br /> m <br /> BUILDING CONTRACTOR: Rignpq bi,'ek—man <br /> v <br /> -1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 r 1\ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. /t , p W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OSI o. <br /> m <br /> m z <br /> 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). a \O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO In a <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 SU <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> 4— <br /> MUST BE SIGNED AND DATED BY THE OWNER. F 1 <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. A uv <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <br /> CONDITIONS OF PERMIT: Q <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER r� <br /> SETBACK AREA. �•l <br /> 5. <br /> M m0 > O a 0- 0 <br /> 6. N F3 O. ry JOcd7. l=. 3 <br /> Z C N ry O N = 1O <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m l0 <br /> PP ( 9 Y ) Y Y � : C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m n_ N <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize E m m0 <br /> PP (� 9 Y ) 9 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `� m <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 permit county officials charged with administering county ordinances or other `D <br /> authorized person to have access to the abo a described premises at any reasonable time for the purpose of inspection. `D n <br /> .1 m <br /> oC r <br /> SIGN HERE J l/-Qt-t L J, o- <br /> (si n#�rree�ofowwneer�or building contractor) � [ 0 <br /> ZONING ADMINISTRATOR 6r/ I 1 la 1c�Qh <br /> �fA fR fA fq � N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> T PERMIT SHALL EXPIRE ONE YEAR FROM DAT OF ISSU NCE� V/ <br /> "arm je�Wnv(!ed -k SaIR l< rn ,L <br />