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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 /> rn � <br /> C VlJ <br /> 6 <br /> OWNER GR9(, TELEPHONE <br /> MAILINGADDRESS 3e2 Y S ��J�7" NSt� �� .. / (/ m <br /> r <br /> 0 <br /> PROPERTYADDRESS �iIip �' -jp)V1 V,-S o i, kod r. <br /> r <br /> IPC LO <br /> LEGAL DESCRIPTION(see tax receipt)S'Z LppI�T / - J5Vy -i:5V �O ty <br /> 49 D11 <br /> DWELLING/BUILDING Iql GARAGE/ACCESSORY.STRUCTURE ❑ ADDITION ❑ (n O \. <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRAD,,IN//G ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: !�D/N Fi �aB�.tJ 0 I <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p73 <br /> �) n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) G�pc a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 30 L'+ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). rn \ t\ 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. ( ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O O <br /> BUILDINGS,ROADS, LAKE,LOT LINES. r� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. v�IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 3 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN `* <br /> NEEDED. � w <br /> L� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: I <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 /> X m0r- > 0a0 -0 <br /> 6. m x3 nm OXRMcc 0- 2 <br /> A <br /> 7. 0 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - U? ' r^ <br /> PP ( 9 Y ) Y Y 21 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G) : <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 m E o <br /> providing in this apocation. I agree to t county officials charged with administering county ordinances or other ,o m <br /> authorized person ave acceils tot ab a described premises at any reasonable time for the purpose of inspection. <br /> T <br /> � D <br /> m a : <br /> SIGN HERE _�i_ 2 7— (353 <br /> (signature of owner or builQing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> J �69 fA fAM�N <br /> -� ouNioct"ict"ivNio <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br /> Ty.I��P � <br /> ERMIT SHAYL EXPIRE ONE YEAR F OM DATFYF;PSU�INCE p <br /> f at (seew a <br /> m '( k1j <br />