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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3, <br /> w O <br /> 1_ 1! <br /> OWNER Y\Ja �'y 1� � � V1 TELEPHONE <br /> m <br /> D O <br /> W ,'S sy�7z f <br /> MAILING ADDRESS � � (YJ b�( G ` �� ('f' N � <br /> PROPERTYADDRESS 2 -7 2F1 7545+ 0>e (111 401 -�- �C Vt 5�C V �L5 5-q g, <br /> Lo s �I,10+11 11'a <br /> LEGAL DESCRIPTION(see tax receipt) �eV�1S� �y �aK�unA' INNS (Fdd✓w-II <br /> A <br /> DWELLINGIBUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑tt� 1 2. <br /> STRUCTURE/ADDITION USE: �� 3�+ aVd e qµQ (og2q Lck 0+ C&4k— 0 -� <br /> wl S ✓t cg (H me/Cabin; Commercial Business: beeoro�om; Deck; etc.) � <br /> BUILDING CONTRACTOR: YrO f 5� I AYEy"a'`II�- 'y ' " fit` �c`�`3R 2 E <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A y Q t <br /> Ol�bi <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n <br /> „ o o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m f� <br /> NORTH(N). �,3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO rrl l� 3 <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF –1�. 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 TO4z> p <br /> BUILDINGS, ROADS, LAKE,LOT LINES. ('l <br /> O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N r <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2. lJ t <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 ( .� <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o O <br /> NEEDED. c O 4 <br /> t� O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q) VOG <br /> ISSUANCE. xJ T <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. MAlWrAD1 2 /0' SeaacK Fro», Say AeSorP%w� of FfaNa QoWrt (Nutt: d > o a o � <br /> ?oE ` LA g <br /> / D�GL ✓ Dnli <br /> g_ P0vW54/E <br /> ¢CC?SSaro co <br /> 7. A)D4- -ro us4 fpr hanki, habl &-h& . m <br /> n: O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n •=c„ "' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether t1 is- n ? 0 E <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 v 1[ d ; o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the ab ve des bed premises at any reasonable time for the purpose of inspection. T n <br /> D ' ¢ E <br /> SIGN HERE <br /> (si nature of owner or bui(ding contractor) (date) , <br /> ZONING ADMINISTRATOR im Fanlan <br /> Q O N N W W N O <br /> O (nON � NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> TS PERMIT SHALL EXPIRE ONE YEAR F OM DA E OF ISSUANC <br /> V J2rm i f-d- 1,e.-fie r me I I.e d - � n r7ikl L 11 D� <br />