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Burnett County'7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> V1 <br /> OWNERTELEPHONE <br /> oy! V , r y �7�W-A ✓��� o <br /> s / 0 <br /> MAILING ADDRESS <br /> 0 <br /> C�PI� �d <br /> PROPERTYADDRESS J&(L,) ( <br /> LEGAL DESCRIPTION(see tax receipt) Z617 2 co <br /> 7 <br /> DWELLING/BUILDINQ;;� GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ �� <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ � <br /> STRUCTURE/ADDITION USE: la Y 0 <br /> I (Ho abiinn; Commercial Business;Bedroom; Deck;etc.) c <br /> 2. <br /> BUILDING CONTRACTOR: ���`�l� �' �" ✓�' J 0 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> x N Cr <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m M <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m c� 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. <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. r� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONINMAZ TC.,THE PLANS C>C <br /> MUST BE SIGNED AND DATED BY THE OWNER. { f 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. SEP C 2003 'I o <br /> CONDITIONS OF PERMIT: BURNETTO' <br /> zpZONING1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT COUNTY <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. , Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Cy <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SET ACK ���(J <br /> 5. Qnsl S'Q3 l IDI ► , ' �u/!�//79 SI T�� ; 0 r cDi 0 Da O a <br /> 6. �U Yhe�F Q5 C�e rn're� � ]y(1L i K✓Q � v &y N o_ gymm 3_ <br /> (?Fjoa lcu1�/ / 51 a�� !/cG,Jev'cc fia`q�snjw/�1 <br /> / n M <br /> I declare that this application includin an accompanyingschedule has been examined b me and to the best of m - r^ ' O <br /> PP 9 Y ) Y y C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m 0 : .n <br /> a v <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize m O <br /> that this information 1 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 o <br /> CD Cn: <br /> authorized person to h access the abb escri premises at any reasonable time for the purp se of inspection. o <br /> m <br /> CD r <br /> SIGN HERE -?©w JLn <br /> =f of owner or bui ding co ctor) (date) <br /> ZONING ADMINISTRATOR v>t» <br /> t fA EA fA EA � N <br /> �y O (T O0 OA OO <br /> TOWNSHIP PERMITS MAY BE REQUIREDl i°"� IVVV� <br />