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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> u o <br /> /J �7 -7t�wy �7�+ h N <br /> OWNER TELEPHONE�� _ > 27 / 7 d'! <br /> MAILING ADDRESS <br /> m <br /> O�VSL <br /> r � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) :Ze CO'n d Judd To Ha vAl d ylp'y c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ElADDITION K (n 0 <br /> TYPE OF PERMIT(S): c <br /> FILLINGIGRADING ❑ CTP I G NIT ❑ SUBDIVISION ❑ c' <br /> STRUCTURE/ADDITION USE: I <br /> (HomelCabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> 7 <br /> m 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 17 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) ,( [� / /y p <br /> /i77(� <br /> 1 Z <br /> . ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN O DRAWN TO SCALE, n �. p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(E IAND ALL NEW BUILDINGS(NB)AND INDICATE m '? \ <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m D3 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F t <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m�� � oao � <br /> 6. ,'r3 R2 xa � A <br /> v p m C:0 ii' S3 <br /> 7. Z ya � o Bio <br /> P T <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my N A <br /> PP ( 9 Y ) y c . C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of d n ' N <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m E i ` m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- L7 `� cn <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i 01 fD i <br /> m <br /> authorized persoqA have accesstfthe above ascribed premises at any reasonable time for the purpose of inspection. i i j <br /> Mm n : <br /> D : <br /> SIGN HERE / f-ALt Q a [ <br /> ( gna re of own uilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> �(A fA 63M� N <br /> TOWNSHIP PERMITS MAYBE REQUIRED o x o u v o <br /> THIS PER IT SHALL EXP <br /> Oy E YEA FROM DATE OF ISS ANCE - <br /> f:' (Mj+ 4-�� Plc c d u p ` � (�i1 beef �trc�sbur� <br />