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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of <br /> APPLICATION FOR LAND USE PERMITS Hing Administrator CD <br /> v ci z <br /> 3 0 <br /> r <br /> G "~ <br /> OWNER �+ p <br /> N O <br /> r T TELEPHONE <br /> �j /V <br /> MAILING ADDRESS W Z�"'7p �jl�y6.S /� <br /> �otirt�l� /�.t✓ SO 7 O <br /> PROPERTY ADDRESS <br /> 302�y /,s/. ✓!LS u P,� �'f 1 <br /> LEGAL DESCRIPTION(see tax receipt) N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LXJ ~ <br /> TYPE OF PERMIT(S): o` <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ��� Cr <br /> a <br /> STRUCTURE/ADDITION USE: � � // <br /> PI�C-A-1 c)5q-3 ryi o �. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) /YlQ( <br /> BUILDING CONTRACTOR: A( J7tjN�L T op 36;t co <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. CID <br /> 3 <br /> T 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> N <br /> O m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M p z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m J A <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 CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> D AREAS. <br /> 4. SHOW THE LOCA OR <br /> OF THE WELL(W)RIVER AND MEASUREMENT <br /> SEPTICTANK(TN AND DRAINFIELD(DF),AND ALL DISTANCES TO nn a <br /> BUILDINGS, ROADS, LAKE,LOT LINES. � <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS J o f <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. (n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � OJ <br /> CONDITIONS OF PERMIT: o <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. CS' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. , <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC <br /> SETBACK ., ALLOWED WITHIN THE REQUIRED WATER <br /> 5. � �AUA. / /� / _ <br /> NU I-f'lJ!•lil,� II�Nv.Q K6L e-w-,4*ed <br /> 6. CD C <br /> A W n r D p D D <br /> 7. m x '0 am n- am A <br /> omC0,05 3 <br /> o cymo : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my T� O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of : n m <br /> to <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize Vp : c v C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether g i e n <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 . <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other W 0 <br /> o • <br /> authorized person to ave a ass tot b described premises at any reaso 'a i ' <br /> I m m <br /> SIGN HERE - n <br /> CD i i i <br /> CD i i i DE <br /> ( <br /> v> n s' re of n or building contractor) � a <br /> 77 (date) <br /> ZONING ADMINISTRATOR JAN o <br /> J 92005 <br /> TOWNSHIP PERMITS MAY BE REQUIREDU1 W W <br /> BURNETT COUNTY � N WW ID <br /> o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUX NG f <br /> "(led � �O(/]Qj�CO✓1S/� tcG�zdn a 4-0S <br />