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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office o�zoninng AdhTfii§VAA NP a) Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> r <br /> y O <br /> H <br /> OWNERO,,,l A• r1oaK�AM TELEPHONE '1 l5 - X55 3723 CD0 <br /> MAILING ADDRESS S'71 -��.Sor��Y �Vni 2n4 ��55� �� r� o <br /> ela (D <br /> PROPERTY ADDRESS�PI I roe <br /> -bz P Road we�,si`r wL <br /> Left S 0-t aura: t tMoP no. 833 olu�X� + <br /> LEGAL DESCRIPTION(see tax receipt) <br /> pp_j., G5 IbUrrA Cozen <br /> co <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION ❑ a <br /> TYPE OF PERMIT(S): W o` <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a 7 <br /> Rome. <br /> SN D 614)21gr <br /> STRUCTURE/ADDITIONOSE: TfOMa �6�;n c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ' <br /> rn <br /> BUILDING CONTRACTOR: _Ql.Jnc�f- <br /> d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 y <br /> O m <br /> v a , <br /> �. I. 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 m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF • <br /> 2 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO E <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> V S. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Lel <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 <br /> SETBACK AREA. <br /> 5. <br /> 6. 33 0 m °' � � �ia � � <br /> m aamX� � ]m7 <br /> 7. 'a m C y y O j <br /> Z N ( O ; O Co <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my o T ;` p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n ; S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in detem <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying to rmining whether to is- <br /> this information I am ` m �` i7 <br /> providing in this application. I 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 reasonable time for the purpose of inspection <br /> m <br /> o : <br /> T O <br /> SIGN HERE ��/D¢ m E iD E <br /> fn <br /> Pq <br /> ignature of owner or building contractor) (date) i <br /> ZONING ADMINISTRATOR [� <br /> �J 6 <br /> 11 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N c <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />