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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> OWNER DLIJZ" TELEMM (� )a-3 6 - 1517 o � <br /> m <br /> MAILINGADDRESS J�'7C�g �/� �L��� � F��jr/O �/y��✓) SSI�y� e _ <br /> r � <br /> PROPERTY ADDRESS )Al lJ`G�(Z ��� �� 1 <br /> LEGAL DESCRIPTION(see tax receipt) L Y <br /> --6oy z-or-#a p"�b� <br /> W w <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING 11 CAMPING UNIT ❑ SUBDIVISION ❑ CL <br /> STRUCTURE/ADDITIONUSE: C,6 " " D <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: — 1 <br /> M <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o Z)6 <br /> Tl O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m �^. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C 0 <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 �J�� <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. IN <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRA ILLED. <br /> 6 IF SEPARATE PLANS ARE B SUBMITTED <br /> OWNER.RCHITECT, ENGINEER, BUIL gE r .�I E PLANS <br /> MUST BE SIGNED AND DATED o? ft^ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE ERIFICATION MAY BE DONE HEN v 1 <br /> NEEDED. [4AR 2003 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: BURN77E1�7 COUNTY <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEF49NINC I <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYLA <br /> O C <br /> PERMITTED. LA It) <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE <br /> REQUIRED WATER <br /> SETBACK AREA. -��L 1 / / ' F- <br /> 5. <br /> OK to <br /> SSG/2 e_l�'mi t WIfA <br /> 6.b,��r G�J►�2�, recorded 9-as-o3. °%° (D x n_ �_ <br /> S a o n a ry m <br /> a mC:WWa 3 <br /> Z y N O 0 -i* <br /> 7. O -n`C ; ;I <br /> m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my G 2: C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> L all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o rn <br /> that this information I 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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized p on to have access to the above described premises at any reasonable time for the purpose of inspection.r CD <br /> o : <br /> CD <br /> SIGN HERE <br /> (si ure o owner or building ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> 0 <br /> (�EA 01 EA to 0 N <br /> �" UNiU1(TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED /ll� <br />