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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator C0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ^ r <br /> f� <br /> a Q� <br /> OWNER L Gil15S�.. Roh Do!,r.� TELEPHONE TIS- L(P3- 2Z9Z. <br /> r� I I m <br /> MAILINGADDRESS 7Sa 2•t� st 51.E LIC4r L.tit[Q (�T' S�00� 0 <br /> n r � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) I,-o 1 V �/cvQ^-�� �k��`� •^ - l/o..' .��L� y I'4 O \ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 11ADDITION El <br /> 0 <br /> TYPE OF PERMIT(S): C 1 Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> < B <br /> STRUCTURE/ADDITION USE: o/rt e- ? <br /> (Home/Cabi ;owtc-1 Zotl Ak .,s Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: all N V <br /> m <br /> 1 Ic. /t!� �^. <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. q�� C--)n ,�I!n(i A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) ((ff `71C lJK—l.S�i p O �, <br /> T o. <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n � p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). a \ n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF lY Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. O o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. ^` 'zz� :E d <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. w_N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN (a <br /> NEEDED. ' / M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. vj <br /> CONDITIONS OF PERMIT: P Q, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <br /> ISSUANCE. r,� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Qv l <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> � d01 0 of m <br /> 6. m x3nm0a = A <br /> o <br /> 7. Z C p m C y <br /> N N O � <br /> P N T� m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize [ m C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' <br /> OS � : <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 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 reason I 'on. <br /> T n ; <br /> SIGN HERE l D w a <br /> (signatyre Of owner o�yilding contractor) (date) <br /> ZONING ADMINISTRATOR �--t�f ;r/ Li U DEC 20 <br /> �NfR EA Vi N <br /> TOWNSHIP PERMITS MAYBE REQUIRE[I31URNETT COUNTY G o Nn o N o <br /> THIS PERMIT mSHALL EXPIRE lYEA RFROAT /I�Ss" <br />