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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> O <br /> OWNER 'T—' �r0� "n�' tp�� TELEPHONE & J;g Crf f/' n <br /> MAILINGADDRESS 1 �y 77 6, 1 17 ,F,� f• ( Z �p � <br /> a 1 r nJT- L � 0�`tf <br /> PROPERTYADDRESS Ia3IR s' uiS O's, Rom d(— Lj Pppne- wy, �J o C� <br /> d (V''vl � <br /> LEGAL DESCRIPTION(see tax receipt) 4-6 4--7 C 46oZ Lp4 I mac, (D -f-r{DNR Q v, � <br /> 2 b <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ j(� p <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING n❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: �6OLRCE ReoF of- 2- <br /> `J o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn O' <br /> ^ m <br /> BUILDING CONTRACTOR: '- <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 (� <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p m c <br /> 'n d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. MZ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o A <br /> NORTH(N). <br /> m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m y 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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENNEEDED. <br /> ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ^. O <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <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. .r " <br /> 6. Flbor Or fibK ltaf;6" agpfoV,AAe_ �Ur Ltrldll- 7y,j_ q_ <br /> AA�� JJ :U m ()rD OD O <br /> s. NO <br /> M <br /> �7 tit 1+10r1Q I 1 1/ll 1\� 'SF0102_ K�l Lpe- r(GLGC o x o a M0 x c- <br /> A <br /> 7. n y ad���iona,/ �sfi-u. u.ralal4�rat�o�s wail r�yui�e a. VQfiaoce . Z = o " 3 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of iGQ o 2 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize r <br /> mthat this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `° :sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 amm 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 tS the above described premises at any reasonable time for the purpose of inspection. <br /> m n : <br /> : <br /> SIGN HERE <br /> D8�r ; n <br /> (signs f owner or contractor / (date) i o : <br /> ZONING ADMINISTRATOR <br /> �ERfA fA to N <br /> O N N W W O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N o e, _ o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE O ISSUANCE <br /> tP4-aI -i I le 44er�, Lei' -la 7Ce OonSiruchon <br />