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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _ Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N - E51- 3 y 3--5/ 91 5T o <br /> N <br /> C 11 <br /> OWNER Al tfa b e r } - A6 ,c li l" y it s' TELEPHONE 7/j- �f-q `3 / Ip d <br /> 6j <br /> /� lw <br /> MAILINGADDRESS /O/ S Ak 4akE S /�iorf Q;n, A A /(re L'/ Mn, 5_S6w v <br /> R o <br /> PROPERTY ADDRESS `,Z `I'� ye No ASCeh, Aa�C Tr'"/dwg4 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® LU co o' <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: A4 C M t�� C 6 %n 3 ti 5 o c. j K H �o a ►. <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> In <br /> r� t <br /> BUILDING CONTRACTOR: /�0 6 S� �/•e c S�'I f � <br /> v <br /> m <br /> m � <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. m <br /> z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) pCD <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. fj A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m C` <br /> NORTH(N). rr\ <br /> n <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d <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 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 MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 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 /> 5. SETBACK AREA. <br /> 6. Addi7ia�i ��ax �� iAStea o� / V x�� + r�X �o/ lolt cLdcf/norl, n00 0, :E m <br /> m � � - � <br /> C y W <br /> 7. Z fn ry 0 O <br /> O 71 M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d .n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <br /> sue a permit. I further accept all liability which may be a result o yang on this information I am w <br /> providing in this application. I agree to permit county officials county ordinances or other o <br /> authorized person to have access to the above described premises at any►eason e t r the purpose of inspection. (D C <br /> r o : <br /> 9 2003 _ <br /> 9 M <br /> SIGN HERE t • U 3 "' [ <br /> n : <br /> (si ure of owner or /ild�ing contractor) (date) <br /> ZONING ADMINISTRATO <br /> K) 0 <br /> o�(N EA Ut ER N <br /> ZONIN{3 ' m—_ NJN N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> /l/J) (liOtTN00 <br />