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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ 0 o <br /> APPLICATION FOR LAND USE PERMITS <br /> CD <br /> OWNER , A VA �0 t- A w li: )D II? U C 1C TELEPHONE SP7 , 0 7 OGa <br /> v <br /> m <br /> MAILING ADDRESS QC, C f ah C C .0 Q �� _� C *O <br /> PROPERTY ADDRESS On! :31,AiC- Li A; <br /> LEGAL DESCRIPTION see tax receipt) �/ / 73-7 W <br /> m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Pil rn 5 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING CAMPING UNIT El SUBDIVISION ❑ q <br /> STRUCTURE/ADDITION USE: 6 jr) P o <br /> (Home/Cabin; ommercial Business; Bedroom; Deck; etc.) v <br /> BUILDING CONTRACTOR: t J O �� ' �O 11 5 "a C f C u 1, <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 W ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n-n <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) pCD <br /> -n a <br /> � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m O 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE J <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Cl) <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Do R W <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o 4- <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( N U <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. <br /> co f 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o 0 9� <br /> NEEDED. pc <br /> _ t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o G t <br /> CONDITIONS OF PERMIT: •r t` <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � (� <br /> ISSUANCE. ^ U <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. }� I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <br /> PERMITTED. N 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X W 0 r D O D 0 -0 <br /> 6. macm3 a 0, n x <br /> p N C(ony O j 3 <br /> 7. Z cin � o <br /> o CD Tom : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — ` A <br /> PP ( 9 Y ) Y Y ' O2 v : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � v � • <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ((' m si m <br /> �(J . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- cn <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 0� ? � m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized persqAto have access to the ab ve des ribed premises at any reasons ati n. (D <br /> -n a i <br /> CDCD D <br /> SIGN HERE � a <br /> (s eMf n99" bnuildiinng contrnact^or) DEC <br /> (date) � ' 0 <br /> ZONING ADMINISTRATOR 1 ' J I vim' I �l l , DEC 2WS <br /> Li U �fA 69'W Efl N <br /> TOWNSHIP PERMITS MAY BE REQUIREDBURNETT COUNTY o o K) oWW <br /> N `n w w o <br /> o <br /> THIS PEF IAIT SHALL EXPIRE ONE YEAR FROM GATE OF ySSL <br />