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Burnett County 7410 Co. Rd. K, No.102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER ! 1 S vll f4,N SON TELEPHONE 763- <br /> 0 <br /> MAILINGADDRESS ��� I.L�cr��/ _ l�S VZ /Vjj ,tLE � /� S-5 o <br /> r m <br /> rnrn p Q I O <br /> PROPERTY ADDRESS 60SU Z& L AIS -£ t�D �N�(�� W1 � C4 <br /> m <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Cl) > <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ .ren <br /> C� �- N VJ <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; Commercial Business; Bedroom Deck; etc.) <br /> :3�^� <br /> BUILDING CONTRACTOR: �LF m r_ <br /> m Q <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> TI m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> m <br /> In v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). UCi <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 t G� o <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 W <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2. o tl <br /> MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN = SU <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 9 , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. (/1 <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. <br /> 5. <br /> CD W w w n a f m <br /> 6. m 3 n m x a A <br /> p m <br /> Z c m N <br /> 7. o m Tom : <br /> = tn m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m 0 <br /> PP ( 9 Y ) Y Y � � N C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of M <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m c mCDo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> (A\ 0 : =r : <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 Vim; m O <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable t I ion., m <br /> T <br /> 1 CD <br /> m D <br /> SIGN HERE — <br /> signature of owner or building contractor) (date) <br /> ZONING AD/MINI/S�TRAT/OR SEP 1 2004 / <br /> ll�,?�/ `�evl\ ... OON41 kA W W NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 9UPINETT COUNT' O O v, o v, v, " o <br /> /53 0 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA( ING <br />