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r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - gAD o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> !' ,,.e I.C. -7 15- <br /> OWNER��,(yV('�I� DGt,W-c.i�S TELEPHONE 7 ( �'v�a—�J O•pZ� p <br /> MAILINGADDRESS <br /> 2 6nnn4-17(, 14t:� r- P d Lt) <br /> C4—,:, <br /> PROPERTYADDRESS / , � 2 A�, t <br /> LEGAL DESCRIPTION(see tax receipt) 3— :5,1 , 1110 C LI; L0+ Cf y%A J �P ► �I <br /> DWELLING/BUILDING �A GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <; <br /> N <br /> STRUCTURE/ADDITION USE: ^nQ d <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ( t, <br /> Q � p � W <br /> BUILDING CONTRACTOR: c pe. !e r l� ���"'y.S °' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 00-SI1'c'C-C- 0 <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. - A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �3 <br /> NORTH(N). J <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO Im r� -a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <br /> BUILDINGS, ROADS, LAKE,LOT LINES. I <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS Q 3 0 1- <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o M <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. '�' W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> V <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 5 <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 /> l / r_ � <br /> 5. � tLI` � <br /> QW r NO D O_-p <br /> � En nm <br /> 3am0x6. N <br /> O 3 <br /> Z C to A O O O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ' [ , <br /> »: A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of �: a "' '. A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize • hn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> ! 47 [ <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 pplication. I agree to permit county officials charged with administering county ordinances or other [ m <br /> authorized psytofi to have yosm to!P1 abo escribed premises at any reasonable time for the purpose of inspection. <br /> D : <br /> � n <br /> vn : <br /> SIGN HER ^ <br /> (signtu <br /> are of owner dor building contractor) (date) 0 <br /> ZONING ADMINISTRATOR �I/ wn <br /> m Flan <br /> �fR EA fA fA-+ N <br /> O N O N N l n 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> TIS PERMIT SH��EXPIRE� �OlN�YEAR FR�OM DATE OF ISSUANCE <br /> -j' , <br /> rm� �e6�' � �oe nczr fan lets <br /> I I ,� <br />