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Burnett County 7410 Co. Rd. K, No. 102, Siren,V1f1 54872 Office of Zoning Administrator M o° o <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> OWNER �eQ Ue r A a k r TELEPHONE <br /> MAILINGADDRESS '7a t/ �A�It S IC ✓1 C 1E <br /> r � <br /> PROPERTY ADDRESS 7 A LII- �j��� 4, �p.� 9 o <br /> Sec !-lov, X? Totdn yo �{c,„ <br /> LEGAL DESCRIPTION(see tax receipt) Lo I- 35 CS rn ✓.S t• I t �t S F S O !! <br /> �pI' �. A <br /> J <br /> DWELLINGIBUILDING ❑ GARAGE/ACCESSORY STRUCTURE 4`Lli ADDITION ❑ rn o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ \O <br /> H <br /> 0. <br /> STRUCTURE/ADDITION USE: (r i!` - - <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) d <br /> BUILDING CONTRACTOR: Se l <br /> v 3' <br /> m <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. m (h <br /> M N V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In <br /> NORTH(N). N \ 3 <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 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. (� jz�'. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1513 <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. J � E a <br /> I <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> » <br /> NEEDED. 2 Wy�� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Gj <br /> CONDITIONS OF PERMIT: 5. O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT fp <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 <br /> SETBACK AREA. ��ret6t -N fObe <br /> 5. (Smr +o be ureal far pn vo, -e- re.Std e�41a I ars <br /> u3e[lr/iLtnanha6,Vp/ibh _ 0 a ,M0ma * m <br /> 6. m �'c3 am aOr 3 <br /> 7. 0 <br /> O N T� <br /> m€ m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP (� 9 Y ) Y Y � [ <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? n 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m si _ rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- z : s <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 o E <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 above described premises at any reasonable time for the purpose of inspection. fD a [ <br /> m <br /> n <br /> SIGN HERE 2 5 <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR J/ I m 112 r)(CWIh <br /> 69 fA fA fR� N <br /> ON (n W W N0 <br /> O (I, ONNfTO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT$HA EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> '(M -1- a- !ewi lecl 10 Oe2h Fe lam,►--ate- is-0) Y-Df, <br />