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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 /> fn 0 <br /> kA <br /> p,} +}� <br /> OWNER I .A t^ R A QG` � ! &Arl 9 Qyl 5�_ TELEPHONE `7 IT- <br /> 166- y(@ Ky C,�a o <br /> 7-� 1 <br /> v "I <br /> m <br /> F <br /> MAILINGADDRESS <br /> iNki ,E Soi JA AU Sof. ?Ali,)Ai) A►!4I SS 11,01 <br /> Fj.� 1 • o � <br /> PROPERTYADDRESS -OAn�Uje4r L� 1S( , _r 1.4 O <br /> �9 l 1 _ <br /> LEGAL DESCRIPTION(see tax receipt) LOT CSM V. a, U' <br /> CD <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION LqJ (D 0 <br /> TYPE OF PERMIT(S): (� Cr -1.1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ , ` <br /> STRUCTURE/ADDITION USE: �I V)nG la X!8 W Iti /o xl� P,,r n,,,�a / L <br /> me/Cabin; Commercial Business; Bedroom; Deck; etc.) W _p <br /> BUILDING CONTRACTOR: n `� <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> .'0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a m Z <br /> X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m —9OQ <br /> NORTH(N). � o <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 <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 Std <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 /> q � 52J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN oCD <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4, NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. er,s'k s/aIo5" <br /> a 71• C� � m <br /> oa <br /> mC6. `' o3mn- n �D � <br /> c r^ m <br /> 7. Z A <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of nn,, m n �" C <br /> W <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize 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- m cn <br /> sue a permit. I further accept all liability which may be a result of theCWd <br /> t r� formation I am d o <br /> providing in this application. I agree to permit county officials chaSi(t, nces or other <br /> authorized person to have access to the above described premises a at f e f inspection. m <br /> - a <br /> : <br /> SIGN HERE I a <br /> Fn a ; <br /> (signs re of owner or building contractor) AFN 8 <br /> ZONING ADMINISTRATOR V\MI Glen COUNTY <br /> En: fp <br /> 77 _ �'A EA fA fA N <br /> TOWNSHIP PERMITS MAY BE REQUIR719NING cx�7s-Jhe! o cNn o 4i c"n N o0 <br /> THIS PERMIT SHALL EXPIRE ON YEAR FROM TE OF SUANCE <br /> ma ilei 4o ar-& , I �ccrs+ W)1 fuer -ys- <br />