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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T C) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> HO AA r= esa- 9v/o-Ya)7 N <br /> OWN TELEPHONE(,U�lME2SK12�-H TELEPHONEC96/.L17/S- &66 -837? o <br /> m <br /> MAILINGADDRESS /© SSYa S PY�LASS D. A FDr�FU) 1 edi ILI Ei�f,(J/ SS 3x/I <br /> PROPERTY ADDRESS agar T LL A.IJ-DL IL 1;X -r <br /> LEGAL DESCRIPTION(see tax receipt) y 7-0LLAAJDl=(z- tyCIOO=s <br /> IQ�ra73you- 16 <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING ❑ GARAGEIACCESSCRYSTRUCTURE 1:1ADDITION <br /> FILLINGIGRADIN/G ❑ CAMPI <br /> NG <br /> UNIT ElSUBDIVI ION 1:1 ('6 <br /> STRUCTUREIADDITIONUSE: If/ f�9 "! ) r ( dLYt <br /> (HometUabin, Commercial Business; Bo,mi geGk,'�etc. <br /> BUILDING CONTRACTOR, <br /> { I I� rw l <br /> � y <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> p H <br /> DIRECTIONS FOR PLOT PLAN DRAWING. (AERIAL OR TOP VIEW) O `m <br /> T <br /> n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS IND)AND INDICATE m '^ <br /> NORTH IN). C <br /> 7. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO T a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. I <br /> S. 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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. - o <br /> o, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. - <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT' <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2, REMOVAL CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING <br /> OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> n x3 'o Doa1A <br /> z moN ,o y <br /> r ? <br /> on <br /> I declare that this application (including any accompanying schedule) has been examined 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 v n u <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize n 5 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is. m m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnell relying on this information I am v o' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have <br /> access <br /> lto'the about described <br /> npromises <br /> ' at any reasonable time for the purpose of Inspection. Ter <br /> QI�M.-t'C1Y- W +yc. iD D <br /> SIGN HERE Dve <br /> I n urs of owncrpr e,;la�e=�=rracro.I (mte) g� <br /> ZONING ADMINISTRATOR ti/�{}� <br /> A3a7q- S�uC) ONONNi O <br /> yySy 6G7C,3,�f' TOWNSHIP PERMITS MAY BE REQUIRED C <br /> THIS-PUMIT SHALL EXPIRE ONE YEAR FROM D TE OF ISSUANCE <br /> 1 erA i} 4- I&Wr art led -k Anne Weirn ersrireA 7- »� <br />