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Burnett County 7410 Co.Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m 4 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER 1` W � �iwe.x�c l Nc) N-ALN TELEPHONE <br /> OMAILING ADDRESSj,?0yj <br /> I � <br /> PROPERTY ADDRESS - <br /> 7�' v <br /> LEGAL DESCRIPTION(see tax receipt) �f S� �QbAO�F ��a �o U,q L„ p'� <br /> DWELLINGIBUILDING ❑ GAFAGEJACCESSORY STRUCTURE ADDITION m <br /> TYPE OF PERMIT(S)' <br /> FILLINGIG�R/AOING 11 CAMPING <br /> �UNIT 1:1 SUBDIVISION [] <br /> IVB l` 2 <br /> STRUCTUREIADDITIONUSE. —Y70rte' �(]MI lA e0oth 66ryoC)M <br /> '(Homa/Cabin <br /> ; Commercial Business Bedroom; Deck, etc.) <br /> BUILDING CONTRACTOR: TH — O <br /> � y <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN IV X 11 SHEET OF PAPER, ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O N <br /> A ur <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m S <br /> T ¢ 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCE$TO BE SHOWN OR DRAWN TO SCALE. m o A _ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N (((\O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m V 19 <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND GRAINFIELD(DF),AND ALL DISTANCE$TO \ <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. r.^ <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. W m f <br /> o " <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN — 9, X/ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT'. VI <br /> Y �� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT xJ 1 <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 C, <br /> PERMITTED. <br /> T NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> A W3nm oaoP <br /> Z mo u is <br /> =a ( O <br /> I declare that this application(including any accompanying schedule) has been responsible <br /> by me and it the best ac of e sj n C <br /> knowledge <br /> and belief it is true,correct do complete. any <br /> accompanying <br /> 1 am responsible for the detail and accuracy of an <br /> all information thisinrcontained in this ing will en relied <br /> upon <br /> any accompanying schetlule)and I further declare that recognize m <br /> an <br /> that this information I ac providing will be relied upon by the County of Burnett Wisconsin in in g on this <br /> ng whether to is- N <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this Information I am i : o <br /> providing in this application. I agree to permit county officials charged with dm <br /> ' t ordinances or other — <br /> authorized person to have access to the above described premises at any reasons t h on. <br /> SIGNHERE <br /> (signature of o�sr , King contractor) 1 JUN 2 Iba 2006 ) V1 <br /> ZONING ADMINISTRATOR I �� /�L �� <br /> wa <br /> BURNETTCOUNTy OSNONNUo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALLEXPIRE ONE YEAR FROM DATE OF ISS NG <br /> /m + f 1�1 Plckep a J Ir-ha ��iYYY /// sly -01 06 <br />