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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o� — o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> JIAJ Sal-28e-<?5 <br /> OWNER A '1 116 `E !�V5AJLJ TELEPHONE WK 67_ 2$5= ef Jam, <br /> MAILING ADDRESS 3 Z 3 /t° t'�J W p� j� /' f, SQ 00 <br /> Q,, <br /> PROPERTY ADDRESS 13-0 G u Ai /�U A.. S 60/Ve4 /V= l <br /> LEGAL DESCRIPTION(see tax receipt) I UW IU 4F h& L b7-6?4 2-31-1z1-61-0 1 <br /> Com, <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ b:� N <br /> TYPE OF PERMIT(S): y�� <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ .V �^J a <br /> STRUCTURE/ADDITION USE: /YC/M (2- <br /> '(Home/Cabin; <br /> L'(Home/Cabin; Commercial Business;Bedroom;Deck;etc.) c <br /> BUILDING CONTRACTOR: ✓ELF <br /> d <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY.INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M H (1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D <br /> n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a v; A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m OQ ti 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. o <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. :EO <br /> CJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. o o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. l5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: C> <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ((l ) <br /> ISSUANCE. n , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. XJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. Vl�Tff_� <br /> M (� rDODOM <br /> M � cMi of m <br /> 6. �O m <br /> �am <br /> o 3 <br /> 7. Z wmo -{ <br /> I 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 oA <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 m: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to jr0e access to the above described premises at any reasonable time for the purose of inspection. fD Cn <br /> o : <br /> SIGN HER <br /> (signal u f owner or ding co c or) (date) a <br /> �/J N <br /> ZONING ADMINISTRATOR ll�/ <br /> G 6r+uzc0�� 2/(c{ <br /> N N N N O O <br /> (lO tT (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED PWB L <br /> asvgq/v# <br />