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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator IL a o <br /> APPLICATION FOR LAND USE PERMITS <br /> 5303 <br /> OWNER eYYH ►'lamS' TELEPHONE <br /> >v <br /> n n L OL-�k <br /> MAILING ADDRESS ` <br /> co On Yrc� P , weadLiLA <br /> `� ^� ^� ` o <br /> PROPERTY ADDRESS 3 7 �F I o.n Ya it 1,22 r U Y f U It P <br /> 00(0- 24/7- O(0- 000 36 <br /> LEGAL DESCRIPTION(see tax receiptC\ W <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> CLc <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITIONUSE: [�G \ZrX 2.9' clecjtA-e rear oP Cal <br /> (Home/Cabin;Commerci usiness; Bedroom; Deck,etc.) m ~ <br /> A � Lx&-o z l°�9cr `N�w,.` 9-3-OL PtrNnc �" <br /> BUILDING CONTRACTOR: ,u <br /> `� shawe 2 --1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n ^' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a <br /> �l Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 3 <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. P <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. v Iv <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. a o <br /> 0 _ ; j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o v <br /> CONDITIONS OF PERMIT: b -4, ' � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �. I <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <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 <br /> SETBACK AREA. <br /> 5. <br /> Nrn aE m <br /> W <br /> 6 .m 3 a % a m <br /> 'o vm CN o = C <br /> 7. Z in f o.' 0�0 q <br /> O Tom': M <br /> _y: i i rn <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> Rai l ; <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- Q� J <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am / m <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 ab escribed premises at any reasonable time for the purpose of inspection. m c <br /> ( <br /> SIGN HERE m m .� �-o"� mac: ` m : <br /> n ure of o u ding contractor) (date) 0' <br /> ZONING ADMI S TOR E <br /> a in to <br /> 99) <br /> �� TOWNSHIP PERMITS MAY BE REQUIRED T1ui ooT IS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />