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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> c <br /> OWNER IJP T TELEPHONE <br /> m <br /> MAILINGADDRESSjv/w O <br /> S f <br /> 1 � m <br /> PROPERTY ADDRESS 24-1RlQ <br /> 03 g <br /> H /K� <br /> LEGAL DESCRIPTION(see tax receipt) S� ��i <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION o a <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMP UNIT ❑ SUBDIVISI N [I:] <br /> n <br /> /P < <br /> W. <br /> STRUCTURE/ADDITION USE: /� �j�f¢/ �r �-) <br /> THome abin; Commercia'I�usl ess; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: IS <br /> L d' <br /> m t <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O — <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O m <br /> T n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �^ <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)70 ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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. U <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 p <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o 0 71✓ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MAY BE DONE WHEN 0 v1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o '. <br /> CONDITIONS OF PERMIT: <br /> � I <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 09 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. � .�// <br /> 5. <br /> //1 /J �r��•.-�rc �i C(/i"t"Ji TC 'Vw4V / L� Lu �o cm �Oi r cDi 0 n 0 m <br /> J=. <br /> o'r o n y m ° "— A <br /> m c <br /> 7. Z c H m o <br /> P m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — 2 i O <br /> PP ( 9 Y ) Y Y ' �� p v ; C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 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 m . 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 Burnett relying on this information I am ` d o <br /> providing in this application. I agree to permit county officials charged with admini c ,oiF <br /> authorized person to have acc to the above described premises at any reasonabl h o s i I� �D ' <br /> n <br /> T <br /> SIGN HERE <br /> lure o <br /> ( ig er or building contractor) AP 'detenOOt o <br /> LL UD J(� <br /> ZONING ADMINIS T <br /> BURNETT COUNTY v ONO W W N O <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED 6 E3 `n o � o <br /> THI ERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> -/'y Jbh�rsah E7a4Wrlses 14- Il-bb <br />