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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M G) o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O^ <br /> C <br /> OWNER , TELEPHONE (QL /rt y � 1 <br /> -7 q-78a O ,, <br /> MAILINGADDRESS �/ C ) O <br /> 1121 S aV OV� L �F4ec' t � i1'to <br /> m <br /> PROPERTYADDRESS &y ZC� M LEp-70CJ/L) t27L- <br /> � 1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ y o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o: <br /> STRUCTURE/ADDITION USE: 0 n �' <br /> (HomelCabin; Commercial Business; Bedroom; Deck; etc.) rn U1J\ Irl <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO 3' W <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O m <br /> T n <br /> m <br /> 7. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO to 0 <br /> M 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I -P <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. n 1 o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO KJ <br /> BUILDINGS, ROADS, LAKE,LOT LINES. IS� :* <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 DO <br /> MUST BE SIGNED AND DATED BY THE OWNER. R. <br /> o (( <br /> O W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, Z <br /> CONDITIONS OF PERMIT: \ r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C, �<< ty <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. D J oI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> 5. SETBACK AREA. J �` '�I r� G� L,, <br /> 6. �7 I l.(,$r?'/Gf f'T7' r {'1 U,l�'1-Ari JI,b TCLTi Un a'�JGU�G2�/si U✓QGiC Dl7 y• ; m o0, � cam, 0 a f m <br /> 0 o W CN ." o53 <br /> 7. Z cinmo 0 � q <br /> m rte [ m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — N A <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of [ d <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize [ m $ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 a ee to per it county officials charged with administering county ordinances or other I °1 : <br /> iu : <br /> authorized perso ve acc o the a=describectfpiftnises at any reasonable time for the purpose of inspection. <br /> m a : <br /> / m ° > : <br /> SIGN HERE-. <br /> (si na e o owner or�build! tractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> �bi Ee fA 6i� N <br /> O O tNli 0 (�1, (fin N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> XWS fV rry- � 4-SHALL <br /> o 4-461-n-igf-Lp- f D 3c&�� S I E <br /> ft 9'� <br />