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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of <br /> APPLICATION FOR LAND USE PERMITS Hing Administrator o 0 <br /> O <br /> OWNER r, N <br /> y <br /> TELEPHONE / a f� V/'52 S G j <br /> MAILING ADDRESS ' <br /> 3 A KC �'I Ta,(/6'A 7iPf)I< GWR N T 104R K /L <br /> _4::Zn <br /> PROPERTY ADDRESS 3 7 6 < ( O U�(/ 1_ P/) r m <br /> DAA/6uR93o � <br /> LEGAL DESCRIPTION(see tax receipt) C L) '"D C' po /y AJ <br /> CD <br /> 6o I- �U-ls ► � �, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 2 <br /> TYPE OF PERMIT(S): m o` <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION LISE: CL <br /> fL (E Zd A 91 AI u <br /> (Ho /Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 44 4 g <br /> Pk &S � 7 <br /> iv <br /> Z � <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. m0 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) N C <br /> c 1 ) <br /> 1. a <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _n m 1' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE z <br /> NORTH(N). �9 70 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING3S)TO m �" /� <br /> AM OR RIVER AND MEASURMENT T <br /> WETLAND AREAS. <br /> 4. HOW THEE OCATION F THE WELL(W)ESEP ICTANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> 1 " I z <br /> BUILDINGS,ROADS, LAKE, LOT LINES. o <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CO o <br /> MUST BE SIGNED AND DATED BY THE OWNER. Gj ,ETC.,THE PLANS <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI,JTlpy <br /> NEEDED. � Elth!►a v <br /> w/ t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �A/y <br /> 8 z L S <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �o,Y COVNr l p V�1 Q' <br /> ISSUANCE. ,tl r / �l J p' I' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY t <br /> PERMITTED. OO Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER J <br /> SETBACK AREA. <br /> 6. <br /> 7. CELS/ (D a a m a <br /> D <br /> W N O j <br /> Z H W o <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my op D <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of y cc <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (� Co, ' 31 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E ': ` m <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 . <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other ` m <br /> m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> n E m i CD <br /> SIGN HERE u�—r~` sf ,� m o <br /> s -3 -�yCD <br /> (s tufle of owner or bull ontractor) <br /> (date) a <br /> ZONING ADMINISTRATOR <br /> r� fA fA E9 fA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED j}✓Y�'' N N N N O <br /> NON Vr p <br /> b'L THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Sul,}� _ <br />