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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N /T <br /> i C v\ <br /> OWNER V2M £ 1 ('JET A LL TELEPHONE VI/Jp -2-q a?' s �\ <br /> 50 <br /> MAILING ADDRESS A6 '4 P� f.(JW �li /J.�� Moo 6�; q2o � r O <br /> PROPERTY ADDRESS Zg$`�� 6j ) ?jcp <br /> LEGAL DESCRIPTION(see tax receipt) LDT Z 615 9 V 3 PJ ��1� Gad �1' L�(JJ 5 b\DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 11 ADDITION \(n O <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADINGS ] CAMPING UNIT ❑`'S�BDIVISION ❑ J <br /> STRUCTURE/ADDITION USE: SUN Vw a rh &J E>I t S(i �6 -DECK- 0 J <br /> 66 C (Home/Cabin; Commercial�B.usirZess; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: EPW JT�P' ��Jixy-cTiop <br /> v U <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PER. ANY INCOMPLETE OR T 3_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A N C <br /> ' I m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r 5egf p st-nLO ` O Q <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN O SCALE. 1 n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 (/+ <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF C Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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 1 J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: �A <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W QQ <br /> ISSUANCE. \ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NN�O�STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN T� REQUIRED �! / <br /> i�TpFiw�Ze AREA. y ``H 6J�7�t/'..v'(�_ <br /> 6. m �'c3om � am � <br /> C y to 0 = 3 <br /> Z C fn O P <br /> 7. O m Tom ' m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — O <br /> PP ( 9 Y ) Y Y 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 1 recognize m m <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' (n : t7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rel i t' d o <br /> providing in this application. 1 agree to permit county officials charged with administer <br /> authorized person ave acc a ab ve described premises at any reasonable ti i f i e ° a <br /> j (DI r [ <br /> SIGN HERE n <br /> ( gn ture of o n or building contractor) 11 d e)4 tMJ o <br /> ZONING ADMINISTRATOR L I <br /> BURNETT COUNTY <br /> ` fA fli EA EA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING g o 0 o C." 0 <br /> THIS PERMI SHALL EXPIRE ONE/ YEAR FROM DATE OF IS UANCE <br /> rYIR�`�2�' Ad �s)L--Ow Con5JIT ,Z -70n 01-d-0-t5- <br />