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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T 0 o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER WI LL TELEPHONE �;5� S3 - 73/ a <br /> Q m <br /> MAILINGADDRESS qo Jp�1So/J 57, kI�i4Fj fC5 W1 SYo2� v <br /> 11== <br /> PROPERTYADDRESS g0(V5 czytb G spoa"64- kv <br /> LEGAL DESCRIPTION(see tax receipt) • <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ C/ <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING FICAMPING UNIT ❑ SUBDIVISION Ela <br /> STRUCTURE/ADDITION USE: bk-o $ l/� J a , (6 I l�a/ r Ll��l <br /> (Home/Cabin; Commercial Business; Bedroo ; Dec ; etc.) rn <br /> d <br /> BUILDING CONTRACTOR: <br /> m f <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. T <br /> O .L <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C G '� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn 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 O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. n O <br /> b <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. F 1 <br /> o W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> 5. /p+f//I <br /> SEj$ACK REA. <br /> "�'-1y <br /> m C m m cDi M a f m <br /> 6. m 03am0, � <br /> a o m CN o 3 <br /> 7. <br /> Z c y m o -i <br /> o m <br /> _ u, : m <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. 1 acknowledge that 1 am responsible for the detail and accuracy of 0, <br /> all information contained in this application (includin y accompanying schedule)and I further declare that I recognize m p <br /> that this information I am providing will be relied on by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. I further accept all liabilit which be a result of the County of Burnett relying on this information I am o <br /> providing in this applicatio 1 agre o per ounty officials charged with administering county ordinances or other j <br /> authorized person to hav c s he ab described premises at any reasonable i f n <br /> m <br /> � D <br /> m n : <br /> SIGN HER <br /> si atur of owner b ilding contractor) (date) o <br /> ZONING ADMINISTRATOR MAY 2 r20 <br /> O �fA EA EA EA�N <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> BURNETT COUNTY CD 0 M 0 <br /> THIS PER'gySHALL EXPIRE ONE YEAR FRO DATE OF ISSUA?i�ING <br /> { m: l�� l /nCcT)e a - a 011100-, <br />