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Ontsrfjohnsor\ Carz <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning AdMini5tr8tor T D Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> r <br /> rn o <br /> c <br /> OWNER L�6 J I TELEPHONE <br /> A/ L 11 }\�, <br /> MAILING ADDRESS CD 0 <br /> g I o� �At,K/J►I it'C� O uta F�Ou.15 Lu' � t = <br /> �w u �_k O s6.1/'1 � <br /> o <br /> PROPERTY ADDRESS C' r <br /> o C�20-It11"1"6-ton <br /> LEGAL DESCRIPTION(see tax receipt) 51 A -T o <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING 1:1GARAGE/ACCEESSOMRlY STRUCTURE v❑O ADDITION? <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5. <br /> n �j <br /> STRUCTURE/ADDITION USE: S e Q SO WA L (,W d m <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> - Cn <br /> -� <br /> BUILDING CONTRACTOR: Pte- C S D a 6nJ1-tZ G O e, <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING_ (AERIAL OR TOP VIEW) 0 a <br /> n n �O �1 <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o O <br /> NORTH(N). C <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 z <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 o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. t Q <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,CONTRACTOR, ETC.,THE PLANS t o F� <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' O <br /> o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o W <br /> NEEDED. ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 0 <br /> CONDITIONS OF PERMIT: o O <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> onsl4e <br /> 6 <br /> m c w mm m CL :E Mm = 3 n m O a m A <br /> Z N y O (O <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ° v A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of cn : C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <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 m o <br /> providing in this appli ion. I agree to permit county officials charged with ad i her <br /> W CD <br /> authorized per ha ccess to the above described premises at any reaso o t f i i n. m <br /> SIGN HERE C a <br /> D ; <br /> ( 169 Cl : <br /> si nature of owner or building contractor) t o <br /> ZONING ADMINISTRATOR <br /> �1 I �(GU�i �n MAY 2 ( CZ} <br /> BURNETT COUNTY <br /> \ �Efl ffl EA ffl�N <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> ZONING �§ �a � o <br /> THIS P RMIT SHALL EX IRE ONE YEAR FROM DATE OE-ISSUANCE <br /> �din( 4- 4- Teicr M0,ltd -tD R46c-s6r) C-UnS�(CtC&r\ &- S_C..� <br />