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Burnett County 7410 Co.Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator -a 0 z <br /> APPLICATION FOR LAND USE PERMITS 3. = <br /> = o <br /> OWNER M./V� (. �� (L.- TELEPHONEgSa -ggD .• 7653 0 CF? <br /> j 1 <br /> MAILING ADDRESS f 7Q(� � a(r�"-A�.IFl1 r S &w5Jii4eyN V rs�� 33� p o <br /> PROPERTY ADDRESS 4, q 3 F '�J"_ 1//r e 1 T' �IZ u^' Cbs i t IG- \ IgJ�1 <br /> LEGAL DESCRIPTION(see tax mcarr) WT I5 CSM J P I �q (I106dJT GT S) <br /> DWELLINGIBWLDING ❑ GARAGEIACCESSORY STRUCTURE 1:1 ADDITION w <br /> TYPE OF PERMIT(S): _ `o <br /> FILLING/GRADING ❑�n CAMPING UNIT 1:1 SUBDIVISION ❑ �- <br /> STRUCTURE/ADDITION USE: u W r�LJ D'� <br /> (HomelCabiinn Commercial Business: Bedroom: Deck: et+cr.) m <br /> BUILDING CONTRACTOR: 1 G 1�.. l/O YSI P� STr qlJ = <br /> v <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON LEAST AN BY X 11 SHEET OF PAPER. ANY INCOMPLETE OR r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO m l� <br /> A x V <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O o <br /> T <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. () d Zp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). w v o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO in o <br /> CENTERLINE OF ROAD,(C)BUILDINGS)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. O <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,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. m g <br /> 0 3 <br /> NOTE: NEEDED. LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o <br /> NEEDED. - <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: ( 1 n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT VI <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. <br /> ]I WOd nonoT <br /> A <br /> m m p n y <br /> T. z � <br /> on <br /> in _--__ <br /> I declare that this application ist ru (including a any accompanying schetlule) has been responsible <br /> by me and to the best c my C <br /> knowledge and belie(it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize ` a m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. <br /> sue a permit. I further accept all liability which may be a result of the County of Burne"relying on this information I am o` <br /> pmvitling M this a icalian. I agree to permit county officials charger,with administering county ordinances or other - <br /> authorized real haveac the bove tlescribed promises at any reasonable time for the purpose of inspection, iD <br /> _ T <br /> D:. <br /> SIGN HERE - S _ <br /> (aignatore f owner or building contractor) _ ( <br /> ZONING ADMINISTRATOR e <br /> 7 <br /> /95 0 TOWNSHIP PERMITS MAY BE REOU N N � <br /> g S PERMIT HALL EXPIRE ONE YEAR FI30 DATE BkIIgAfijWG1g0UNTY <br /> a4� -6a�� Ye rf1U� 4 Erysfiq rZ0NING <br />