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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 /> N O <br /> OWNER O ��k� TELEPHONE 102- O o2.S-•Sa �r� v �\ U,y <br /> MAILINGADDRESS 320:7 f. Od hovrn eG1y-,-1Qn15 *N 55)ID8 <br /> CD <br /> <1 r <br /> PROPERTY ADDRESS Sy l 3 Labe gd o <br /> LEGAL DESCRIPTION(see tax receipt)f y �{ �P� <br /> ' 247 T9 f AlA - R )S�✓ 1 <br /> �7I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION )aJ 1 (n ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o. <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) (n <br /> BUILDING CONTRACTOR: Tk e C0As*41oc f. e)n ^ <br /> m <br /> m <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. 0 fp <br /> M m � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m SL) <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. 1 I <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, BUILDE7Nc'IjE <br /> R, ETC., THE PLANS 1 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. Lir/'� �l o £ t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V IFICAN1 » o v 1 <br /> iNl <br /> NEEDED. p q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. MAy 8 Z a <br /> CONDITIONS OF PERMIT: BURNS C? <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER <br /> Iv�NINOUNTY p <br /> ISSUANCE. TONING Vi � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J'✓ <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER W <br /> SETBACK AREA. <br /> i dmcDimnFm <br /> 6. , /l� �'. 3 nm W am E <br /> 7. N (ND O O 10 <br /> O T m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of @ in <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m - o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �' m <br /> O : <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> ^� m CDm <br /> SIGN HERE �/ ��IOz d' C <br /> CL <br /> (sliffiature of owner or building contractor) (date) O <br /> ZONING ADMINISTRATOR <br /> N) (n N � O <br /> VtOUt O <br /> TOWNSHIP PERMITS MAY BE REQUIRED Sq3� <br /> witc-, <br />