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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> F o 0 <br /> N [\ <br /> C WSJ <br /> -X1OWNER ¢ TELEPHONE /S-lo.�6—3aa n coo <br /> C/ar0/moi •C <br /> D o <br /> MAILING ADDRESS 8/G3 �'Ot' n �opd r�i7�uYt/i L Z -`y��3d F <br /> c /PROPERTYADDRESS nur� Grl0 m <br /> Sic q 7//'`!o N, /Gfu W <br /> LEGAL DESCRIPTION(see tax receipt) A"Wer' AFS kD 39 11y3 In� irnou>< lofs �P-,Z �A <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE 9 ADDITION ❑ `f <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING F1CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: A6/77t!�' — QGI' 0 <br /> 0 <br /> /�n1 (,Ho/me/Cabin; Commercial Business; Bedroom; Deck; etc.) (nt� <br /> BUILDING CONTRACTOR: _ /J /STI iGIC �/Jfel^Qj'iS�cS `V <br /> m <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. n ` /► <br /> 0 y , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n h <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 /> 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. o <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 0 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m cwm r, mnF m <br /> 6. m �'c3 am � nm <br /> 7. Z C y 0 O ,p <br /> O mG <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> pP ( 9 Y ) Y Y � „ : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of f m 0_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeU' m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m cn : l7 <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 c� o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable, m <br /> m a <br /> m Dd <br /> SIGN HERE an n <br /> ( gn ure of owner or building contractor) I (datef W3 0 i <br /> O <br /> ZONING ADMINISTRATOR Lj 11G <br /> ( <br /> V VNi r� I <br /> TOWNSHIP PERMITS MAY BE REQUIRED SURNETT COUNTY (�� OOION0 \\l/ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FRO"ATEi OF ISSU ING <br />