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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r� <br /> y O r <br /> OWNER TELEPHONE J <br /> o <br /> MAILINGADDRESS �jQ� `ly�jER Cy IIVPX/AS Mit/ 0.?�V � O <br /> PROPERTYADDRESSlG/ <br /> a9oS' ��"e z4ge All DANBkRv Wi 5`fA0 <br /> LEGAL DESCRIPTION(see tax receipt) 03d'5a i 7— 03 yl„tO in <br /> m <br /> A <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ti o 10, <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: ��ii{li W�}� �A/Q f/y�'Z ? <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O y <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O m `� <br /> T Z Q <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C .� n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF O I_ I R <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 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. o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN n Q I <br /> NEEDED. (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT P <br /> l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITb rnr D. <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 N <br /> PERMITTED. oO <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER .� <br /> SETBACK AREA. <br /> 5. <br /> D7 W 0r- > ODO M <br /> m c w m m m a f m <br /> 6. m z3300a , ;D <br /> O p N C y �' O 3 <br /> 7. Z C y N o <br /> i [ m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — y ' �++: O <br /> PP ( 9 Y ) Y y E G� C <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 $ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> �: <br /> sue a permit. I further accept all Iiabilit ich may be a result of the County of Burnett relying on this Information I am <br /> providing in this application. I agr a my officials charged with admini t ' c c t `^ <br /> authorized person to have acce ove described premises at any reasonab 1 = p `-g' m E [ <br /> n <br /> : a : <br /> SIGN HERE i rn a <br /> ignature of ownerorbuilding contractor) �� �(dUtaoob o <br /> J . <br /> ZONING ADMINISTRATOR <br /> BUR'NETT COUNTY <br /> O � OUWi NtNTO <br /> TOWNSHIP PERMITS MAYBE REQUIRED ZONING <br /> THA PERMIT SHALL� � � <br /> XPIRE ONF YEAR FROM ATE OF ISSUANCE <br /> mif �- 2- -{-el p(�keu,�, yKev,�, /7�cNlchols �-a8-a6 <br />