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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 /> N <br /> 0 <br /> 779-ISI) C li� <br /> CD <br /> OWNER j;i�fC .�I TELEPHONE I✓— �'Z - �S',/`/�7.�`j 7 p <br /> MAILING ADDRESS Z Ci,& fj/]7t GItp,,r Wjll r ;r-f- /Nin/ / SS//G; CD <br /> oCD <br /> PROPERTYADDRESS L 'LSN �!�—[tee { ¢7'� � + /,lam S'�✓ iC �/ S 7J��� <br /> LEGAL DESCRIPTION(see tax receipt)LoT I&TwTk, S A D`. cJYY1Z Lc t5 Sc c Z> T`fuik+ ►`I ((� CD <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE I/� ADDITION ❑ " 1 C ° <br /> TYPE OF PERMIT(S): O <br /> FILLING/GRA ❑ < <br /> DING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITIONUSE: �� �i-P � �'JQ', <br /> (Home/Ca ,Commercial usiness; Bedroom;Deck;a c.) ori <br /> BUILDING CONTRACTOR: T&,iA)�fcv�lflL� yJ `�L <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C S_ n , <br /> NORTH(N). to , (7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �3 <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. ° <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. b <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �� --I° I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAIrSI�F ° <br /> NEEDED. Tyy <br /> � � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J SEP _ 6 200 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM URNE7T <br /> ISSUANCE. �'C�N r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ZONING <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. 9 <br /> 4. NO STRUCTURES, INCU INMETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACKA A. L('/tarct. <br /> 5. I ►�- �I►�r► ` -o CAI l6-w , roachm <br /> 6. I .° N T w m j7. <br /> 3 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to 06 best of my ' 1q A <br /> W <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of @ r, : v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- GI : <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> Cn <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> CD t / m m' : <br /> 69u <br /> SIGN HERE © a <br /> (si at of owner r building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N U 1 N N 0 <br /> NO (T (T <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />