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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> HOnat N a <br /> �1) <br /> 95,1- 43-2- 11094 <br /> OWNER)gLA1J kJj) /hA�ZG�R�1f � Ijj3 eTSl TELEPHONE 715-d5f- 7L i7 CAarP o <br /> MAILINGADDRESS 13445 144001/EZ CT LC V/144o l/ AM 551 2-Cl <br /> PROPERTYADDRESSd 5693 ✓OVNGte I4fJ� DAA BUX V/ 1,!/.L <br /> �/ 1�A 6t'S <br /> LEGAL DESCRIPTION(see tax receipt)GOV�T LO 11 I, SC C7�01�'� , Lor1 of CSM ✓O!, �� 9/i�l� m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION yr 0 <br /> TYPE OF PERMIT(S): a ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADD1 ° <br /> , Ube <br /> (Home/ b n; N <br /> \ Commercial Business; Bedroom; Deck;etc.) c <br /> BUILDING CONTRACTOR: G K RVTS 13U►�.17ZNG DES=GN m Ul <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> :C N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. E5 m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !° <br /> NORTH(N). -Q!i <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF J <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. U J I 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. r N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CQ R, ETC.,THE PLANS RT0 Sy <br /> MUST BE SIGNED AND DATED BY THE OWNER. J o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF ATION NVI�/FI 1. ° <br /> NEEDED. , rJU <br /> CONDITIONS OTHIS PERMIT ISF PERMIT: <br /> TO ALL CONDITIONS LISTED BELOW. eUp 2042 o �l <br /> t ISSUANCE.DRIVEWAY <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI ZO/Vj N Q j/v� b �\ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G V II <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 (j J <br /> SETBACK AREA. Y <br /> 5. <br /> M d 0v vm <br /> 6. 3a " ° m <br /> $ m x � <br /> 7. O N <br /> Z';! : .ZI <br /> T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m a m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- OQ m <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the <br /> above described premises at any reasonable time for the purpose of inspection. ° o <br /> CD <br /> SIGN HERE IJIJ�Lt �� nL�JAJ� -��'�01 ° o <br /> a <br /> (signa�of owne building contractor) (date) <br /> 1 � d <br /> ZONING ADMINISTRATOR 1con <br /> EA EA EA �+ N <br /> N u l ty O <br /> (n O Gn O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />