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ON COMPUTEWf§Q"yE�g Administrator c� z <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> APPLICATION FOR LAND USE PERMITS 3 �- <br /> r <br /> N ° � <br /> OWNER Pq.M E( IA & (r i.�A, TELEPHONE 6 Ij -*.I y- d <br /> d <br /> MAILING ADDRESS 303'-7 P4Yk /qa 1/p � <br /> / fllj /i tAA) YJ <br /> �+ <br /> PROPERTY ADDRESS a. 9 S 1b n✓14ARC&py i(14 Ek J�A.rJ4b- � ULAV �r Y,?-Ap <br /> LEGAL DESCRIPTION(see tax receipt) i-6 i —HayI dCn L2Kt ,S.'q 7740 <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING` UNIT ❑ SUBDIVISION ❑ <br /> STRUCTUREJADDRION USE: 146jrPL C �4 0' <br /> W Commercial Business; Bedroom; Deck;etc.) Um) <br /> _ <br /> BUILDING CONTRACTOR: S ♦'rj %Si Y- lltr-91 71 <br /> '- <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 71 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. cc on si}Z ok J a-,Z.O -ov TO ^ ..� <br /> ZI N C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. <br /> T Z <br /> 7. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m f? r <br /> NORTH(N). C rR \ O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m L• (7,03 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF tV Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. J N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS O 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. n o <br /> 4 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a R <br /> CONDITIONS OF PERMIT: I <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. N A-- <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. W <br /> S. <br /> 0 DODt7 101 <br /> 6. 3x00 <br /> a` mNN > > 3 <br /> 7. Z mo m <br /> T� A <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myc' <br /> - ^' A <br /> C_ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> a c <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 determining whether to is- Q) 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 N m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> mi Ni <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. = . <br /> p : <br /> SIGN HERE �` yv.: Il� �L'1wi:( ----� �`� /3 <br /> a : <br /> (slgnatur of ner or b contractor) (datef C <br /> ZONING ADMINISTRATOR v i <br /> Gtn f»wf»�n'i <br /> G N O (T N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> I ckjP �y Srt. y i.s COrks� /a a9,ov <br />