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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v Q z <br /> APPLICATION FOR LAND USE PERMITS 3` <br /> N O <br /> N <br /> OWNER A R R �/ G 3 9 S TELEPHONE l �8Y 35 y o <br /> MAILINGADDRESS pJ�`j �lG�7J��/ f�.<Ac•P ,L/ AlkOsl ibis/ S O/� 0� <br /> PROPERTY ADDRESS 7�.rio7 _.e �+./�k� R0/4./ Q <br /> LEGAL DESCRIPTION(see tax receipt) S �,/ T ya AZ 11 t'--1 % C'S«. ✓b//ry r'-Z? 3 ` m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ( m 0 <br /> TYPE OF PERMIT(S): Cr h� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ IWt a <br /> STRUCTUREIADDITION USE: _G R/'1 r�y p 0 <br /> (Home/Cabin; Commercial Business,Bedroom; Deck;etc.) cn <br /> m <br /> BUILDING CONTRACTOR: 1-16%j N k ff y"urLt Sy.>/ �I�S !966 ",3.3 d �) <br /> - 5r %za2 <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. 3 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> 'TIIn 'n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i ^( <br /> NORTH(N). C lJ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v/ \ Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. �t 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 `e W <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 0 -tom <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z .. <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� <br /> ISSUANCE. X� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER L <br /> SETBACK AREA. l" <br /> 5. <br /> This structure to be used as private residential ;u 0 r a v Do v <br /> 6. garage/storage only. Not to be used for human CDN "m 0M m <br /> a <br /> )0 37. nrn <br /> habitation. D <br /> o T � M <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of myC <br /> C <br /> c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d v, 55 <br /> : <br /> all information contained in this application(including any accom anying schedule)and I further declare that I recognize (D o : m <br /> that this information I am providing will be relied u on b t `D <br /> p g p yq yyl�Tn in determining whether to is- C`y <br /> sue a permit. I further accept all Ii bill which may be o f/� (atying on this information I am m <br /> providing in this a lication. I agre permit county r m ifl,,q county ordinances or other o <br /> authorized perso have access t abov escribe remises at any reasonable tim for the purpose of inspection. fD <br /> ��" " MAY 2 0 m3 `/ 0 <br /> SIGN HERE <br /> ( nat reof er or buildIngf�'METT COUNTY (date) <br /> N: <br /> ZONING ADMINIST TOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> aCl�q l Gn✓ i1�ISfKC� 1"1-a <br />