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Burnett County 7410 Co. Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator -U G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N J <br /> OWNER J E G h V1 &- J O yC e-- TELEPHONE 715 - G 3 S - 3 5 9 8 0 <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS $p o o N s k <br /> LEGAL DESCRIPTION(see tax receipt) 6/7 ) <br /> r <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ❑ ADDITION to <br /> TYPE OF PERMIT(S): v ks <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: g X /2 SGreer+ porch, a0(0('-;L1an anpf_. 78�X /Gdeck 0 <br /> (Home Cabin;Commercial Business;Bedroom; Deck;etc.) � <br /> W) <br /> BUILDING CONTRACTOR: /O A/ y ST r S E L '- <br /> Q <br /> v <br /> co <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. -nC <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. r <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS I no <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF A � Ny» O <br /> NEEDED. ����JJllll n, N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> O <br /> CONDITIONS OF PERMIT: p�MAy ZI2 /J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEERIJII'f vErr <br /> ISSUANCE. CDU Ty W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G N' r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY v� <br /> PERMITTED. \ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <br /> 5. � �Gt <br /> y_ �{ <br /> �t!P� IU Q1 m AA) A') 0MaF m <br /> 6. , <br /> aa <br /> I'O 3m20 Ox- �: �D � <br /> v mcy " 033 <br /> 7. Z w o q <br /> o Tom : rnrn <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of d `o v, C <br /> PP (including Yaccompanying I 9 <br /> all information contained in this application includin an schedule and I 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- <br /> sue a permit. I further ccept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this appli tion. I agree to permit county fficials charged with administering county ordinances or other o <br /> authorized person to a access to the above descri premises at any reasonable time for the purpose of inspection. ° o <br /> CD m <br /> SIGNHERE C� S O D 3 �" <br /> n <br /> (signatur erorbu din ontractor) ( ate) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />