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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y o <br /> c <br /> _ m <br /> OWNER / ��� 5 TELEPHONE �' �p_s -;� 10`(j(„1 C)S <br /> m <br /> MAILINGADDRESS S,� ,�1) 5�6,t ) /4oe 5l k, I m v 5s-lo,), 0 <br /> r <br /> PROPERTYADDRESS 019 6 otij,'& �Ie kO/ C ]e 6 Ar, c JZ <br /> LEGAL DESCRIPTION(see tax receipt) S /� a� (v b Q, �� CS/r/ (/ 5' U <br /> l e tort - <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ElADDITION cn ° _1 <br /> TYPE OF PERMIT(S): - n �1 <br /> FILLINppG/GRADINGnn❑+ CAMPING UNIT F-1SSUBDIVISION ❑ '1"59,(,93, fv�se)rT�^'1 °'^ I(ry <_ 1 <br /> STRUCTURE/ADDITION USE: 11oC�� 1' �� jot1ge- . Re-roaf : .4dd (cueted eo)r-x 0 <br /> (Home/CabitY, Commercial Business; Bedrom Deck; etc.) C« C } <br /> BUILDING CONTRACTOR: -/ ON J�/(,L,- i C "O j-\ 2 <br /> � .J yq-16 336 7� )�o <br /> 'F6 C/ m <br /> a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 w n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T tb <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> T } _ Z <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m (e <br /> NORTH(N). cn <br /> C o <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 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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N n ' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS J 0 X� <br /> MUST BE SIGNED AND DATED BY THE OWNER. W f O <br /> 0 : t <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. Z <br /> CONDITIONS OF PERMIT: P 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. A / <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Dq <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 C <br /> SETBACK AREA. <br /> 5. <br /> m <br /> m v r > O Q 0 -0 <br /> 6 .m x3 am 0, nm ;0 <br /> 0 N C <br /> Z C N O <br /> 7' ° <br /> = rn : f E m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m E9 I O <br /> pP ( 9 Y ) Y Y G) -4 : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o U <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 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. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonabl t 10 ° o <br /> m <br /> (D al <br /> SIGN HERE f hl 1 ! �O &C c� n <br /> ( at owner or uilding contractor) (date) �: o <br /> o <br /> ZONING A INISTRATOR APR 2 6 2IN5 <br /> Irl ISS/ ScreL,, Pc. a v o N Ln Ln Ln o <br /> 13o/a 6aroyt $ 13 TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY o �^ �^h,/� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUIQNING <br />