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ON COMPUTE{R���SrrANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI Sda 7 Office of Zoning Administrator 0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <67 <br /> G <br /> L1.2 -1Mt -46-1001 <br /> O iD" L{6iZ 'J645 '753c <br /> OWNER lrq✓iS DSP n!►i F l �l 1� �i/J TELEPHONE '�b'zj -)U/ 4i6� d_p <br /> 1nn�',1 st1 O <br /> MAILINGADDRESS 19a06 <br /> �� a V <br /> PROPERTY ADDRESS Zl 'f-�.,y. Yy` �,' �+IFZ -1%,4II 9tfGk"I <br /> vY�r– —� L-3 t-Ib1 -I oa <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION c 0 3 <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. ` <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business, Bedroom, Deck, etc.) m p <br /> /�Q�3c <br /> BUILDING CONTRACTOR: 19� 1 J �LL�—N�s �`�--" <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLET,,ORM� T 3_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. CC (f/ (" O ' Ip, <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) .J �1 !`/'� � /(� O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCAL W n m A <br /> BUILDINGS(NB)AND INDICATE <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW m <br /> C o <br /> V <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO rnr \ -33 <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 'h o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. a o Q>Q <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 /> O � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: 1� <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W Q <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 M <br /> PERMITTED. "V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. A OOOr DODO -0 <br /> m c m d 0 m n f m <br /> ° 3n 2 x a = A <br /> 6. a o� yN `" o �3 <br /> Z C N p O <br /> 21 <br /> m <br /> 7. - m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 1` G) c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of J! n z <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (� <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this app' tion. I agr a to permit county officials charged with administering county ordinances or other <br /> authorized person ve ac s o the above described ises at any reasonable time f e of inspection. T n <br /> SIGN HERE date ° <br /> (s' na re of owner r ilding contractor) ���+ <br /> ZONING ADMINISTRATOR - <br /> O ea to ea f» <br /> 11IUUIII �`j o cn o cn vi rn <br /> TOWNSHIP PERMITS MAY BE REQU ti <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM D <br />