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Burnett County 7410 Co.Rd. K, No.102,Siren,W154872 Office of Zoning Administrator 71 o 0 <br /> APPLICATION FOR LAND USE PERMITS = 1- <br /> to Opp/, <br /> '/�7 1'�vaw OWJJt-r/1-- n 'C' s <br /> OWNER ��NN �S /l /T�� TELEPHONE�y�/._�53 - 0093 <br /> S t/L,L(,aJ/l7'�yZ.��CCpJ • w_m <br /> O <br /> m <br /> MAILING ADDRESS 90-0T�5 �J-10.sx�-e-nJ — e�.�L ()Otz-T14 <br /> PROPERTY ADDRESS 9¢Y3Q <br /> LEGAL DESCRIPTION(see tax receipt) C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): ❑ �� l„ Q <br /> FILLING/GRADING 1:1 CAMPING UNIT ❑ SUBDIVISION G� S. <br /> L. <br /> STRUCTURE/ADDITIONUSE: L A8 /AJ /AFG� 0 <br /> !I (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) w <br /> BUILDING CONTRACTOR: /gVDNV/GCF ( e.tJST ' /ODE' /-EG� in <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY <br /> I/ INCOMPLETE O � ,tt3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y5efhqt`9," <br /> DIRECTIONS <br /> Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) sly- `� 0 o, _ <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 10 <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m W 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF r z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. p <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. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 4N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 3 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O :E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 7� <br /> CONDITIONS OF PERMIT: ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O ' <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. D C7rDODC V <br /> m m m o m a f m <br /> 6. mr. <br /> Q m C' N 0 5 <br /> Z y iP O O t0 <br /> 7. m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m n : � <br /> all information contained in this application(including an accompanyingschedule and I further declare that I reco nize <br /> PP ( 9 Y ) 9 `+ <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- , J� <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 M: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -nm ; a <br /> m <br /> SIGN HERE /0 -7-04 <br /> g ature of o r or building contractor) (date) <br /> ZONING ADMINISTRATOR E E <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PE JT�HmAL E�(PIR OIJ��YEAR OM�D(4TEQ�IS�U E,, U <br />