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r. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m < o <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER I�/7"ih� / L 6 es D t4 TELEPHONE <br /> / r D2r(j GIJr s�r7Z v o <br /> MAILING ADDRESS {� j �g� ' s' T, � <br /> m <br /> PROPERTYADDRESS <br /> ,,T,.� <br /> o�N 3d' � y� <br /> LEGAL DESCRIPTION(see tax receipt) S�(�IiDK-DZ A'NG r m �„ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): Q <br /> Las <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5. <br /> STRUCTURE/ADDITION USE: ! / OAA C ' 9j <br /> Alp(Hoe/Caabiin; Commercial Business; Bedroom; Deck, etc.) <br /> BUILDING CONTRACTOR: A/Oe�#F/� FA) er <br /> 99 II IS F- A/QM(' S' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6Y,X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 OQ iJ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 03 <br /> 0 % <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> T <br /> T � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. - m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C \ o <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO CTI a <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 o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO © p, <br /> BUILDINGS, ROADS,LAKE, LOT LINES. O <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 C> <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> `~ o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ^ <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 9 1 O <br /> CONDITIONS OF PERMIT: <br /> W I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT OP <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Vv', <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. X a) C) >oa o- U <br /> m F3 nrina � .'lm1 <br /> N F <br /> 6. o 0 CN `.' o � 3 <br /> Z c N m o <br /> 7. o m Tom : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 4�— n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- N <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> o <br /> providing in this application. I agree to permit county officials charged with admini t r I I g <br /> authorized n to have access to the abov described premises at any ma nab the e f t m `D 'o. <br /> a <br /> � —Olo —�lJ06 •^ a : <br /> SIGN HER <br /> `2b gn ur of building contractor) I�i !SPR 1 �u 06 <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY c o o o <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> TAS PERMIT SHALL EXPIRF ONE YEAR FROM DATE OF ISSI�ANCF_ <br /> pici etd tA-P bq NOf�in J�araalfse /�'�cS <br />