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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> UT o <br /> OWNER f1 � / A TELEPHONE <br /> Nor,r, V e_ , I �cQ <br /> MAILINGADDRESS f � Cn f <br /> r m <br /> PROPERTY ADDRESS 41 <br /> LEGAL DESCRIPTION(see tax receipt) ey, su yI U) c5 <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ \ Cno <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> a <br /> ❑ <br /> STRUCTURE/ADDITION USE: 13 L1 k�(�t.2Qs� �a X a C7 `rl SZpf t✓ o W <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> m <br /> BUILDING CONTRACTOR: p <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 y� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p — 41 1 ) <br /> W N (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n �lvp�il <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m s <br /> NORTH(N). (n o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m3 <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. 9 <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. C> <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 0) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o i <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> Uj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <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. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY o <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X ED0r- DODt7 _U <br /> na N = n n d m <br /> 6. m �c 3 <br /> (D C y y O 3 <br /> Z C in ry 0 O O <br /> 7. <br /> - m [ m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP ( 9 Y ) Y Y G� � C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of .� o. ^ � <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognizem m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- W U) '. <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m o <br /> providing in this application. I agree to permit county officials charged with administer' other m <br /> authorized person to have access to the above described premises at any reason I r ion. ° n <br /> m <br /> m D <br /> m a - <br /> SIGN HERE <br /> W ur f ow r wilding contractor) ) ' o <br /> ZONING ADMINISTRAT <br /> APR 1 3 • <br /> 69' i9 <br /> RURNETT COUNTY 0 `" <br /> o � oww � o <br /> TOWNSHIP PERMITS MAY BE REQUIRE ING <br /> THIS PERMIT SHALL EXPIRE RE�NE,YEAR c) D(T�OFrIS��� E �I/� <br />