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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. = <br /> L �1L1y� /� � ,/ Q <br /> OWNER <br /> tin <br /> 1 � �At.lf�U TELEPHONE �n1 \ _L� <br /> MAILINGADDRESS SJLgy J nta7(xx•' RtIL �b�'1( �. \,J�10-1�f�, m J o <br /> PROPERTYADDRESS �(J (� I �1� 1RCV <br /> LEGAL DESCRIPTION(see lax receipt)I a� _ yD -I \ w L a esm V I <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ O m <br /> TYPE OF PERMTRS): �a <br /> FILLINGIGRADING ❑f�CAMPING UNIT ❑ SUBDIVISION ❑ �p / C�j� <br /> STRUQTUREIADDITION USE: (nAo `-"tee lx r.-4 U 6 IIpr✓✓l <br /> (H/Io-me/Cabin; Commeer�cial Businem; Bedroom, Deck;etc.) m <br /> im <br /> BUILDING CONTRACTOR: n(1 �l�N / I d n t s -I Y Ialj✓�- D "/ ol1{u�(/ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p H O <br /> T H <br /> DIRECTIONS FOR PLOT PLANDRAWING. (AERIAL OR TOP VIEW) O <br /> T <br /> T 0 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN Sf DRAWN TO SCALE. m T A <br /> t. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE ... <br /> NORTH(N). Fit 3 <br /> 1. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES.(B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ' o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 0. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 F o <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. r� 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. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN CL <br /> NEEDED. f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITION$QF PERMIT: i" <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Vl <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. 1N <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. t I I rLQS <br /> 5 PJo df sF nc�u �� Can bt less # an to +o sfi�e <br /> X m3 AMp <br /> oR <br /> 7. F TZ� A <br /> = m: w O <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my a <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm U <br /> all Information contained In this application(Including any accompanying schedule)and I further declare that I recognize ! m $ <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to <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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other n <br /> authorized person t have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m D <br /> SIGNHERE <br /> (signature of owner or building contractor) (date) <br /> �'m Flar,Lc <br /> ZONING AD ISTRATOR lO <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N <br /> HIS PERMIT SHALL EXPIRE ONE-YE FROM DATE OF 1 SUANCE <br /> /Y)C( le��l-oT0hn- r {!,y &iuer7-ao-o(o <br />