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Burnett'County 7410 Co.Rd. K, No.102, Siren,WI 54872 Office of Zoning Administrator - C 0 <br /> APPLICATION FOR LAND USE PERMITS �. <br /> r <br /> y O <br /> ISON <br /> OWNER J N\ / /AM '" TELEPHONE �6 6 - ��I a L/ n <br /> d � <br /> MAILING ADDRESS � Amled 4, lard SLAP � <br /> CC Lesap : o <br /> PROPER ADDRESS 3.34 7-4b RS 6zV L,ot 3 (fX E loo / <br /> /�a cR .01 <br /> LEGAL DESCRIPTION(see tax receipt) 5c� S. /-Plain St K�oX /N 11053`� l <br /> � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE W ADDITION ❑ <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITIONUSE: -301X3 6 0 <br /> (Home/Cabin; Commercial Business; Bedroo ; Deck; etc.) cn <br /> BUILDING CONTRACTOR: J r �/-4�K/ C/� I r [DU ( �Q/I rnA r �II SL 5; <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n C <br /> Z 2' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y o <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 f� <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 <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. £ I <br /> o ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN y <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: Pq <S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Ln Nrl <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. f <br /> 5. <br /> Mai <br /> may/ ,�f,/� J�n�1 I I / J'�] �I y <br /> /vlai,l D, ( l1 40/ seaCa'� 1 I o- r 1 ""`7�-la -S on �i aF rtl <br /> 6. m3am �c - <br /> / .�� r.� z y m <br /> 7. S 1�,... ��C, o T,< E <br /> T _Cl)1 m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- Ji <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information i am a <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hay ccess to the above described premises at any reasonable time for the purpose of inspection. - o <br /> SIGN HERE <br /> �~ 7 <br /> (signature of owner or building contractor) (date) I a <br /> \/moi i i i <br /> ZONING ADMINISTRATOR_ T"ri panloaz1 ' ) t E E W69 <br /> C, <br /> TOWNSHIP PERMITS MAY BE REQUIRED N zwl o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Ul <br />