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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator MQ z <br /> APPLICATION FOR LAND USE PERMITS 3 G� <br /> OWNER C /,e-Al C' (Q h�-c+ til TELEPHONE g 5 a q� -93 O W <br /> 1e 10 54 Yyt .)j CC (' O <br /> MAILING ADDRESS y,� AVD/1(lm /G>7>k� mR. s J3 7S 0 <br /> c/ <br /> PROPERTYADDRESS �A �� 7 ��� R� /^h� �i✓r <br /> i <br /> LEGAL DESCRIPTION(see tax receipt) pp��1�'�j/� � 7S J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 91 ADDITION ❑ S{rryYcS W 5 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: IZXIb YO✓G�. LaN �(�$75 LA <br /> L _ <br /> ( ome/Ca— Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: _�/lJv�-r-f /+V� Q.-�i„LL.T/UP-� 5 <br /> 1f iue� d <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BX X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n Z- <br /> M � O <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p n <br /> o �• <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t z A � <br /> t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C rr __ n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v'I 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF nn1, <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. SCJ z <br /> 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. g ("�> <br /> 5. 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 J ?l7 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 ,o <br /> of <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN _ B <br /> NEEDED. <br /> t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z C7 <br /> CONDITIONS OF PERMIT: <br /> W P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C> <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY SO <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m c� u0d a�af m <br /> � > > n n o <br /> 70m CNo � 3 <br /> 7. z C N ry O O(O <br /> O m T•< m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ^' O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; iu n : J e <br /> U <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 cn l7 <br /> 7 : <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 application. I agree to permit county officials charged with administering counor i other <br /> o d <br /> authorized person to have access to the above described premises at any reason t 'on. <br /> L u n <br /> m a : <br /> m <br /> SIGN HERE � n <br /> (signature of ow <br /> nor or b�iilding contractor) (date o <br /> ZONING ADMINISTRATOR Jim 1 'an `,rt L 200 <br /> Fd E E E E <br /> - <br /> mt+� ^ <br /> TOWNSHIP PERMITS MAY BE REQUIIREDpURNETT CONTY <br /> T� SHALLEPIEONAiRFRpA9TOF ISS WG <br />