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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 57 0 <br /> GSZ zip r9/y J <br /> OWNERS�E FHE� �. NL=L 5 p 1✓ TELEPHONE 71j- <br /> MAILING ADfDRESS 0 60k 5--e 2 Z E <br /> r m <br /> / 0 <br /> PROPERTY ADDRESS `oz,±&&;-r (Itj*e— Mt Wi ,�dow Fo. 3Sr 3G hal)lfi3 royo>'9601<11 <br /> vlilhye' T4yeL �-tw s 11P. ► \ <br /> LEGAL DESCRIPTION(see tax receipt) /� P19I \ o <br /> gy�pp(( <br /> t 2 <br /> DWELLING/BUILDING 9 GARAG�SORY STRUCTURE ❑ ADDITION ❑ /� <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDRIONUSE: "'46 y N <br /> 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR: Al LS0,,/ SewCe., LLQ '- <br /> m <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a —t��� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n —11Z <br /> JZ <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M a <br /> NORTH(N). <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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN o C y� <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. d <br /> s o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA � o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. APR F I Z <br /> CONDITIONS OF PERMIT: S ?OQ3 I p C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMBURNETT COON <br /> ISSUANCE. ZONINGTY J � <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 to <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> 3 a 0 0 o- <br /> O N C y N O 3 <br /> 7. Z N N O <br /> O � G M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o n w <br /> pP (including Yaccompanying ) g ate : A <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 Burnett Wisconsin in determining whether to is- m <br /> P 9 P Y ty 9 0 : <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. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T MCO <br /> � . t, o : <br /> SIGN HERE . F✓v✓�--�. / ' Z S - 02 <br /> e <br /> (signature wnerorbuildin contractor) (date) a <br /> � r <br /> ZONING ADMINISTRATOR <br /> 1& fA fA 1.9 N <br /> ri <br /> N N N O O <br /> 0 <br /> O N r 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />