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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> ( APPLICATION FOR LAND USE PERMITS N. 0- <br /> OWNER 'K/ <br /> 1 `t4 w l l l ER-- TELEPHONE = lz�-e <br /> MAILINGADDRESS / 2-10 0 S51-84r1,,j Q� /�pn/t+ �j /2, ,/� (p� 5^t/(;(�'� ° (n p� <br /> l� VJKr 4Jl.r 7d <br /> PROPERTYADDRESS <A 0, ° <br /> LEGAL DESCRIPTION(see tax receipt) Z3 918'i" <br /> TYPE OF PERMIT(S): N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION � 0) p <br /> � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: Zia fl-Dow.— <br /> tJ 1liJO t. - o j ]b pcg, o <br /> (Home/C/aj�I_n; Commercial Business; Bedroom; Deck; etc.) ti ' <br /> BUILDING CONTRACTOR: Lei GS rZO,�, iQ.J,s'/(�,(,+ <br /> v <br /> PLOT PLAN MUST BE PROVIDED LEAST AN 8'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> NED. m W � <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) OA m Ce <br /> MR n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n z A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �^ A <br /> NORTH(N). C �- O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m� A1 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ll"� 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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. m F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> N ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. �, <br /> CONDITIONS OF PERMIT: o OJ <br /> 1 ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ( 't <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ((\\)p)p <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER Q <br /> SETBACK AREA. <br /> 5. <br /> s. m co mm0O DO M mm ' 3amOa- <br /> 7. g o ° C m <br /> Z c �^ m o : °2 <br /> ° <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bestof my — �' in m <br /> to <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m N C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m ` reit <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. i vi : 17 <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 I o0i o' I <br /> providing in this applic n. I agree to ermit co my officials charged with administering county ordinances or other <br /> authorized person to v access to a abo abed premises at any reason ec on. <br /> SIGN HERE ! ` D P <br /> yn: <br /> ` (aignat re of owner or building comtpctor) (Rate) ` : p <br /> ZONING ADMINISTRATOR <br /> 1NOV 3 3 2005 ' <br /> p <br /> TOWNSHIP PERMITS MAYBE REQUIRE61URNETT��TCOU NTY O o u o u u <br /> THI RMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISyvxcNCEC' <br /> �mr� � ,,,DATE&7gS�rrn�iir�saruo�a� <br />