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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of <br /> APPLICATION FOR LAND USE PERMITS Zoning Administrator 3 0 0 <br /> N <br /> OWNER /� 763— S�o/ — ams/ <br /> 3G(�0 Yh t C PAN k o w TELEPHONE 71 g- <br /> 41a6 7 ft <br /> o <br /> MAILINGADDRESS 7//a 1016 191,C- Al <br /> O2DG�C,.✓ �Gr✓jGr2 1771y o <br /> S-ya <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 1 O <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION L7 <br /> TYPE OF PERMIT(S): m o <br /> c <br /> FILLING/GRADING 11 CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION f-/__ Q. OGe/C /Ll.ii un /el'fM WAL�jr1[r7 (3)4$E/rI�N o <br /> (Home/Cabin, Commercial Business; Bedroo ; Deck; etc.) co ' <br /> � DO <br /> BUILDING CONTRACTOR: %GNS/ ��/{ly,$OIV � C-OU/�'CG <br /> � A <br /> PLOT PLAN MUST BE PROVIDED LEAST AN 8%x X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> I m <br /> LLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> NED. .n 3 <br /> O y <br /> DIRECTIONS FOR PLOT PLAN ORAWIN (AERIAL OR TOP VIEW) C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M n <br /> ^p z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m ' p <br /> NORTH(N). C N O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m '� 3 <br /> GH WATER MARK(OHWM)OF <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIO� <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 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. F <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. V` <br /> CONDITIONS OF PERMIT: o Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. <br /> 4 NO STRUCTURE <br /> AREAS, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK5. <br /> s. 6}�.51 � - O+ � C � oaov <br /> fm <br /> M xa nM xaA_ A <br /> 7. a <br /> � C m <br /> Z co 41 ry O ; i 10 M <br /> N T`G 0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of m in` m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of �, : u, <br /> y i C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize I ? m ? m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. <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 <br /> providing in tapplication. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pershison to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> i a <br /> SIGN HERE 7-0 e. n <br /> l <br /> (signature of owner or building contractor) date <br /> ) o <br /> ZONING ADMINISTRATOR <br /> O O N(fir,W W I iJ p <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> THI PERMIT SHALL EXPIRE O YEgpR��FROM DATE OF ISSUANCE <br /> 9h ��lYlr� <br />