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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 0 1Z <br /> APPLICATION(FO/RR LAND USE PERMITS 3 o <br /> OWNER yl �?S�� �a? el� po � LEPHONE / <br /> I Ir�N(�E1 Flo1�t o <br /> MAILING ADDRESS71 N AIC C Z� r �lO�Nbl.�f'T I S S y83 C� " <br /> r � <br /> 0 <br /> PROPERTYADDRESS j63()-)j <br /> LEGAL DESCRIPTION(see tax receipt) N l6, 5C S V-) T U 1 7LJ <br /> 00. <br /> DWELLING/BUILDING <br /> GARAGE/ACCESSORY STRUCTURE ADDITION ❑ r,j <br /> TYPE OF PERMIT(S): W <br /> 0 <br /> FILLING/GRADINGEl CAMPING UNIT ❑ SUBDIVISION ❑ C-arr.V 30'K3' < <br /> STRUCTURE/ADDITION USE: H o mtE I.' o <br /> at� 4,A L(�� �/yl(1�, C rfonw 3( X(Ot�` 0 () <br /> (J <br /> c (Home/Cabin; Commercial Bu mess;Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: S-L I <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN B'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M 9 <br /> M <br /> NORTH(N). C n <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 0 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED D. IN <br /> j t <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CON TC.,THE PLANS J 0 W <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q o <br /> o 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER71, <br /> TION TION MAY EN �./ o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. eG'7 I�! z V j <br /> CONDITIONS OF PERMIT: /'/ ? 44) <br /> o h\ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM�Q/ty� C� w <br /> ISSUANCE. ,t^ <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 `^`J3j <br /> SETBACK AREA. <br /> 6. m nnircDi �a0 � <br /> w <br /> 3 nm Dam M <br /> NC y " 0 9 <br /> 7. Z rn o O =I <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my y A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n En C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m � o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 w <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 time for the purpose of inspection. s <br /> -n o : <br /> SIGN HERE —4.2 - o-3 d, <br /> (sIgnat5wet,o,wnje r building contrac r) (date) n <br /> ZONING ADMINISTRATOR <br /> cNii o cNi+ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> /hq�fed -6 P -/7-�3 <br />