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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v OZ <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> f- <br /> -29 -,7030 <br /> LLoi",e <br /> ((,SI�v - J <br /> OWNER �Q a TELEPHONE ((SSI)7(0 2' C)391 (HumeFewlel <br /> '' II'' 5 U3q e 0�Cowll �J��T s 6 6,u c <br /> MAILING ADDRESS �St 4M u WIJ O <br /> r � <br /> Lb-,k7 <br /> PROPERTY ADDRESS 3QS`��1 'u. <br /> mot? et al-4I 13 <br /> LEGAL DESCRIPTION(see tax recei )ptto <br /> Ta,c �e�e Il1o . Z_ yzy—ol coo <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �/ 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION 1:1a <br /> STRUCTUREIADDITIONUSE: �G_bi►7 Scyep✓ ed 10 Al d, y <br /> o' <br /> (1-10e/Cabin; Commercial`7Busin s;/Bedro7om;;DJeck;etc.) ^� <br /> BUILDING CONTRACTOR: <br /> Cf &Z rS'h�I�t z <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET F PAP . ANY INCOMPLETE OR 3 ^� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> 11 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m A <br /> NORTH(N). C ^ n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) v I 3 <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 O <br /> BUILDINGS,ROADS, LAKE, LOT LINES. L <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N �N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, COIN R, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o � <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE IFICATION :1"t'1 E o <br /> NEEDED.THIS PERMIT <br /> �7 <br /> CONDITIONS IS PERMIT: TO ALL CONDITIONS LISTED BELOW. gV� � 2�? o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMT�n CQuNry � <br /> ISSUANCE. <br /> CIO <br /> 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r �/} <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. <br /> m m rcDi O > <br /> m <br /> 3 n OM 0.a m <br /> 6. v tD C y w o Ta <br /> 7. z m m o <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 — ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> PP (including Yaccompanying 1 g <br /> all information contained in this application includin an schedule and I further declare that I reco nize C ; : o me <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O 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 /: m <br /> ' <br /> providing in this application. I agree to permit county officials charged with administering countyi ordinances or other ° <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> m m <br /> SIGN HERE S O <br /> (signature f own or building contractor) I (date) <br /> ZONING ADMINISTRATORtu <br /> W fR fA EA N <br /> UP`joo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />