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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v C) Z <br /> APPLICATION FOR LAND USE PERMITS �_ < 1 ° <br /> � r <br /> OWNER JRLM(4 teL t �F4AA/NA /1'(Ceq LLOUW TELEPHONE <br /> v x <br /> l�[ m <br /> MAILING ADDRESS <br /> U 7 44-rW/ k /Y� f <br /> PROPERTYADDRESS map _ OId 4STS 08 .3exn ' <br /> LEGAL DESCRIPTION(see tax receipt) 1p7- �3 r QED W I A& APO, AD V✓ ��+:�ws{ryp eF JRoc <br /> In 3 <br /> DWELLING/BUILDING Ix GARAGE/ACCESSORY STRUCTURE ADDITION <br /> ❑ ❑ <br /> TYPE OF PERMIT(S): co 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> ���`` 5 <br /> STRUCTURE/ADDITION USE: /�rgYj tr y \ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ' O <br /> n m S <br /> BUILDING CONTRACTOR: M/l.l�K Qu I l.0!'r!S <br /> Z <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) m Q <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(ES)AND ALL NEW BUILDINGS(NB)AND INDICATE m m n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF �P <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. C o <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE VERIFICATION MAY BE DONE WHEN TRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE Vo <br /> NEEDED. <br /> 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. rv` 6 <br /> CONDITIONS OF PERMIT: a I I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. v I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <br /> PERMITTED. <br /> 4 NO STRUCTURE <br /> AREAS, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK5. .( U eT CLQ / s > /Co la .Oj <br /> 6. 0. � ro m ^ a F <br /> K. Sam Fn � A <br /> 7. Z � m oy �(oa <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best <br /> m <br /> of my — m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and curacy of <br /> ac <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is. m <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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have s the above described premises at any reasonable time for the purpose n inspection. m <br /> m <br /> m mE <br /> T o <br /> SIGN HERE <br /> U f9 e i <br /> (signature or owner or building contractor) (date) � n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAYBE REQUIRED N N N N O <br /> NO(n n0 <br /> TIJIS PERMIT SHALL EXPIRE ONE YEAR FOM DgTE OF I SUANCE <br /> er m c� l Lev r- ft -LD P�'n r K�d y� ru pQr--ie 5 <br />