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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 2. <br /> C <br /> Q <br /> /1 n n-e, I I TELEPHONE,,65/-73g 5/- ..3 _g- a6/0 m � <br /> OWNER LC r t C Q <br /> MAILING ADDRESS � Sc kon n e r UL r y o <br /> 55f-�S <br /> PROPERTY ADDRESS(�� A Z M .3707 W6 hoc, 3506s, �;L- <br /> n r ' <br /> TA 46 f OurCOce3� pri <br /> LEGAL DESCRIPTION(see tax receipt)U) �p �la ,q�'Q ,n f" �j�I< i' Ora iL 0 <br /> DWELLING/BUILDING ❑ GARAGE/AC ESSORY STRUCTURE N ADDITION LJ ^� <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ . <br /> STRUCTURE/ADDITION USE: Pole ba r r) (/ Q X 19 W I c)-r` I `-em To- <br /> y (Home/Cabin; Commercial Busi ess; Bedroom; Deck;etc.) WBUILDING CONTRACTOR: & l tri n GA G Ji buy 9' Ly 5 y8�d Cn <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 00 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> -n a �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 rn <br /> NORTH(N). N ", <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ? <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. <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 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. m ° ry <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA.WBE DONE WHEN S nn} <br /> 7y X/ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � � <br /> CONDITIONS OF PERMIT: Sip <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I� 7 j ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE �r / <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY o/V//�U/0-y <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER /� <br /> SETBACK'A. , be io ' -Frvrrl o 2/�Q�1 -tv s, - <br /> y �,�y /` 9 mmc10, AaE m <br /> 6.5. 9��� 0-t � '3D ' fl �m I��jh V f I�IJC�I� s7li�'P_S• m mcy o 3 <br /> 7. of -she- rotd c`,� U—b3 — I fyih f 1 „H _'q A <br /> QQ�� Amo : <br /> A,6W v` 1-TnT1(jr) ° =m : E E O <br /> I declare that this application (including any accompanying schedule)has been exam ned by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C Fs C <br /> CL : ut : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (iC m m o M <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 Qqf',�Q t this information I am So <br /> providing in this application. I agree to permit county officials%' a wl F i i o ordinances or other °7 <br /> JJ�� m E <n <br /> authorized person to h , e access t the above describe mis s e p rpose of inspection. - o ; <br /> SIGN HERE r ''_1 n <br /> (s ature o w r or building contra ) - (date) <br /> ZONING ADMINISTRATOR f i»in <br /> fA f <br /> On to N O N <br /> ONING c� NN � o� <br /> TOW SHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE -1 J <br />