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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 0 <br /> 15. <br /> a �.luo� <br /> CA <br /> OWNER L!C iFJd T7 L£P �(O�j TOo���G.r p <br /> /MBcIN ADDRES9,2 <br /> PROPERTY ADDRESS '/l� �� � <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Int <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION C/) <br /> o � <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING 17 CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: �aX�O?/ W / czh 0 <br /> (Hoom�Ce//Cabin;/Commercial Business; Bedroom; Deck; eefc.) <br /> BUILDING CONTRACTOR: D I C <br /> A PLOT PLAN MUST BE PROVIDED ON AT EAST AN 8'/,X 71 SHEET OF PAPER. ANY INCOMPLETE OR 3 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: AERIAL OR TOP VIEW) O m <br /> T d Z <br /> 1. ALL REQUIRED DIMENSIONS OR DIST NCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OFA L EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). r <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m \ 3 <br /> CENTERLINE OF ROAD, (C)BUILDING S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF P <br /> LAKE, STREAM OR RIVER AND MEASI IREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(N),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. ( Q)11 <br /> 5. INDICATE IF A WALKOUT BASEMENT S PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTEE BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a. o t1 <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (� l <br /> CONDITIONS OF PERMIT: P nom. (OPV <br /> ' DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAIN NG WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m m W m 0 0 FO M <br /> m x3 nrn x- n '� A <br /> p N C ,Nj, N O = 3 <br /> 7. Z cmCD0 <br /> o m Tom : : m <br /> I declare that this application (including a accompanying schedule) has been examined by me and to the best of my G) - O <br /> knowledge and belief it is true, correct and omplete. I acknowledge that I am responsible for the detail and accuracy ofm' n c, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize nJ: m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �y D io <br /> 0 <br /> sue a permit. 1 further accept all liability w o ich may be a result of the County of Burnett relying on this information I am � d � <br /> �i <br /> providing in this application. I agree to pe mit county officials charged with administering county ordinances or other ° m <br /> authorized person o have access to the abi ive described premises at any reason c I n. <br /> T n <br /> SI ° D <br /> m an i: <br /> t» i i ' ' i <br /> lop, (signatur of w buil contractor (date) <br /> NISTRATOR AUG ' 2 <br /> / <br /> lah 9 Y � OWN HIP P RMITS M BE REQUIRED BURNETT COUNTY o <br /> Ga, <br /> THIS PERMIT SHAL EXPIRE ONE YEAR FROM DAT OF ISSU.ZQNN rd <br /> ?"?wr-- 4 Lei'-�erMa,bd-Io la►IIIam �n,99- <br />