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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> m <br /> c <br /> OWNER 7r�qoScrs TELEPHONE c i a <br /> v <br /> MAILING ADDRESS Ro� W A L , LA'- CD <br /> S'Y83 a <br /> o <br /> PROPERTYADDRESS JZEhi! /1H. n, <br /> VJ <br /> LEGAL DESCRIPTION(see tax receipt) OQ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREI ADDITION ❑ rn 0 s <br /> TYPE OF PERMIT(S): Q <br /> FILLINGIGRADING ❑ /CAMPING UNIT El SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: Catryc / C]UssllVuY«sc -310X3D64nir, 16'1. x30 &MtLLCc <br /> (Home/Cabin; Commercial Business, Bedroom; Deck; etc.) CO <br /> m <br /> BUILDING CONTRACTOR: PI�Gt�i P��t, ,7i�c Ro• &ics7e) weLkLx iii v <br /> e U -4 <br /> -U3 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. T <br /> O <br /> 0 y Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n a f <br /> -n a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). (A o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m (� f� 3 <br /> J1. <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. I - P <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. <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 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. £ <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. f1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: p 'V t <br /> \ <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. 3 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY � C <br /> PERMITTED. �T <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 <br /> SETBACK AREA. <br /> 5. <br /> X a) >0nov <br /> 6. m x3 m <br /> 'o =r N C W <br /> 7. Z <br /> om it's : M <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m fJ <br /> ( 9 Y ) Y Y G) � ; C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m �_ <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m rn 17 <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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m D <br /> m a : <br /> 1 l l• .�- n <br /> SIGN HERE _ - <br /> (si tur of owner or uild ng contractor) (date) o` <br /> ZONING ADMINISTRATOR Q <br /> O N O w w N oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FRO [)qA�TE 9�ISS AN <br /> fila L�( 1 v NRao tat (166 c 6S� <br />