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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 0 <br /> N �I <br /> OWNER CJ TELEPHONE `J I - qLo <br /> MAILINGADDRESS (n It(>���� � <br /> o <br /> 8134 B c; <br /> PROPERTY ADDRESS J � - n � v e, <br /> a ;a m , <br /> LEGAL DESCRIPTION(see tax receipt) I ra C nJQ , 3�Q7 t Vol 1$ I o 4 3TO852- <br /> M <br /> Q1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE K ADDITION ❑ (n <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5. <br /> No ma 3�X `" <br /> STRUCTURE/ADDITION USE: _ Qpa�(IQ 1L q 1'J o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) (n <br /> �D w h (� h <br /> BUILDING CONTRACTOR: ND 1 S 111 t: O <br /> m v� <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 /> O (�+` <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m V O <br /> -n n� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m-'1 ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m mC A <br /> NORTH(N). <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. <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, CON _ETC.,THE PLANS on C� <br /> MUST BE SIGNED AND DATED BY THE OWNER. /? <br /> / Lf o _^ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI TION M Y � $ <br /> NEEDED. i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 14Ap Z , Jn <br /> 2003 Z v' <br /> CONDITIONS OF PERMIT: QU I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZONING <br /> 7J (v <br /> N►N <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p� <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1. <br /> SETBACK AREA. L / <br /> 6. j4r/ C ' "��` �/rte' L}?( /C (D or- >0> 0M MW 0 v a o v <br /> 3am " ^ � '0 <br /> �hj arna 1'1 a " N y ^ = 3 <br /> 7. Z n p o to <br /> P Tom : z <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my0 A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m `n v� C <br /> PP (including Yaccompanying ) g M CL ` : z <br /> all information contained in this application Includin an schedule and I further declare that I recognize m O . m <br /> that this information I am providing will be relied upon b the County of Burrett Wisconsin in determining whether to is- m1 . <br /> P 9 P Y tY 9 ! O <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 d <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 time for the purpose of inspection. m <br /> o : <br /> SIGN HERE l l 03 `^ <br /> n : <br /> (signature of o r or building contra (date) <br /> ZONING ADMINISTRATOR <br /> Qhi <br /> r`'1V N(TNNOO <br /> (T O(T fly O O <br /> TOW HIP PERMITS MAY BE REQUIRED <br />