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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> /%A'PPLICATION FOR LAND USE PERMITS 3. ,, <br /> �jarl <br /> //�� / I / // fes ,/ N C <br /> OWNER L S. J O 1T/!/SC,y TELEPHONE�J/���"'� "3eZ�� 0 <br /> m <br /> O <br /> MAILINGADDRESS <br /> rCD <br /> 0 <br /> PROPERTYADDRESS VV <br /> LEGAL DESCRIPTION(see tax receipt) IST CS /' <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE EIADDITION P / co <br /> TYPE OF PERMIT(S): Laoa <br /> !�1 I�I•/1q FI�LINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ / c <br /> STRUCTURE/ADDI f 14 USE: E D 4 0 lU <br /> (Home/Cabin; Commercial B mess; Bedroom; Deck; etc.) U <br /> 2 <br /> BUILDING CONTRACTOR: Q// w <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. O " -C- E <br /> W N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n q` <br /> m �J <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ID <br /> 9 J :b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). fA 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO Im 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Ck <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. (� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS O 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o O f` <br /> o �'} <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o lr�;Z, �1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P <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. <br /> 5. <br /> X cu c: mvo0a m <br /> 6. m x 3 n m n m <br /> Z in m o <br /> 7. o m -n A <br /> = r� : 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 -4 : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o " <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize c : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j <br /> authorized per have access to the a ove described premises at any reason I I T n <br /> G m ai <br /> SIGN HERE a ' <br /> (sig ur owner or ild' g contractor) date) (� <br /> ZONING ADMINISTRATOR i�0 JUL 2 6 2065 <br /> e»: '6 b' <br /> �EA(fY EA EA� N <br /> a N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY��i�u <br /> THIS P RMIT SHALL EXPIRE NE YEAR FRO DATE F ISSUMEENG <br /> I f n+-4' 1�-f�(?l2i le �� ��Sa �ohn,son g-g bS- <br />