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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> V7 O <br /> N <br /> OWNER OAn Ae0a,1140 V C_ '7'!S </j) TELEPHONE30 .\' OO <br /> pt Y-m OCl <br /> MAILING ADDRESS 8 - RAS 49�� O <br /> 44 <br /> m <br /> PROPERTY ADDRESS <br /> 5s=-- lory dy twP, y0 p. r-rW L-0T 3es471 <br /> LEGAL DESCRIPTION(see tax receipt) I(0 P �(f C <br /> 1 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �I b (n <br /> TYPE OF PERMIT(S): w ' <br /> FILLING/GRADING 11CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: D GC.< Mot)t L t) Q Q�('Y) 0 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: ft:�C �M AZ-i 6,211 f iL LAlLAJ' Z41) <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. -n <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 0 <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. c J <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. C C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO GRADE T N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CJJpp T <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC TION A1�ljiffic N N 0 <br /> NEEDED. ��++�rfltT t 4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. BURNE17 COUNTY 0 <br /> CONDITIONS OF PERMIT: ZONING tl' 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY S\ <br /> PERMITTED. R ` <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X W0) 0Mn � m <br /> 6. 3am0Em � <br /> (D C y fn = 3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — r^ A <br /> C)c' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �, w 0 : Fn C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizeQ 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 V 0: <br /> sue a permit. I further accept all liability which may be a re t County of Burnett relying on this information I am O 0 <br /> providing in this application. I agree to permit county offic rMM county ordinances or otherauthorized person to ve access to the above described p i the purpose of inspection. `° o <br /> CD <br /> m <br /> SIGN HERE <br /> (signature of owner or building c ractor (date) ` <br /> ZONING ADMINISTRATOR `JIM fl—an, Bt trli r <br /> �•-r I I <br /> U T/ EA EA EA fA N <br /> r N(TNNOO <br /> Cn O tT tJ+ 0 0 <br /> TOWNSHIP PERMITS MAY RE NN11��QRED Sr% 70 A/ <br /> c;�-'76 36 4-CC <br />