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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> m o <br /> N <br /> OWNER A4 1 KC 4%04f-- k rA-- TELEPHONE (O f - Zdl SOS Z <br /> MAILING ADDRESS 083S- 3'77-0 *-ES. lkk4ACD <br /> fn4 i. 557¢17 0 <br /> p <br /> PROPERTY ADDRESS 7J-2Jr2EA'LSrEp Qu4D1 rJc�,-�d�7 t „vr �f� <br /> LEGAL DESCRIPTION(see tax receipt) 1 No <br /> 2 <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 'Fo <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) � <br /> d <br /> BUILDING CONTRACTOR: 5 �'r'•' O r <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6%X 17 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 �1 I� <br /> c C Ce <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) p C^y <br /> T <br /> r p _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O v� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m S Az <br /> NORTH(N). C e ,� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m l D3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF -J 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 A) <br /> BUILDINGS, ROADS, LAKE, LOT LINES. C�Q ®, <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN 0 t <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. _lam o i <br /> T �J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P 1 <br /> 1 1\ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> / <br /> SETBACK AREA. <br /> S. LII 0U&UitSy/rrTL re- ��IOSBr—/nGn. Blb ,9 / <br /> Of <br /> LIt/L / JLSbe reM <br /> Nax 2Oc-D * M <br /> m3 n0xaM <br /> ."O <br /> 7}- Z <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my ` q I A <br /> PP ( 9 Y ) Y : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> �� m' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize I 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 /> O : s : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relyin on this information I m m o <br /> providing in this application. I agree to permit county officials charged with admini "T i c r "" I <br /> authorized person to have access to the above described premises at any reasonabl - h s i ' m <br /> T d <br /> SIGN HERE r"'r r0 S <br /> en n <br /> (sig olii,of owner Iding contractor) �T 1(dbt•1111f1[ J ? <br /> ZONING ADMINISTRATOR UD <br /> 1. I _CWJ -' <br /> BUfiNETT ` N <br /> O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING o u o u u v o <br /> T S PERMIT SH LL EXPIRE ONE YEAR FROM DATE OF I UAN E 9J <br /> m; + Pe n-xa it" 4o ryit r r� Hca <br />