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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> OMER K W N P�A4 n'L 1��RCeCL d �0Y/S Pc 9—IC <br /> / 6 �� 0.5 7 3 <br /> MAILINGADDRESS �� 3/ rL/ T -FVr e w rLy✓ X t�r I � ��/�� O <br /> � o <br /> PROPERTY ADDRESS G// 74 Alf#LLARd Z.4 e ROAd <br /> �F- a-r.35, Tio p.yo. R./S z-o7 / csni v/y Pi/6 <br /> LEGAL DESCRIPTION(see tax receipt) , 40 <br /> DWELLING/BUILDING EJ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ U) <br /> TYPE OF PERMIT(S): / a <br /> FILLING/^GRADING ❑ CAMPING UNIT ❑ SUBDIVISION E] R' �l <br /> STRUCTURE/ADDITIONUSE: MTT/G d?ym '/1ouSe_ j�:�dAR—ASP1 1 0 <br /> (Home/Cabin;CommercaMuusiness;Bedroom;Deck;etc.) <br /> / ^ ` <br /> � d J U tl <br /> BUILDING CONTRACTOR: l�S E m <br /> m (� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O � <br /> 1I m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c`ColA, <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ;o2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. \ A <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. 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. 0 )U <br /> o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. �» <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. CIN <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Cl <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. y� v / Il <br /> 5. AA�! t-Y errh/ 1 /" U(5-/?s 11 [!/ P/Q/V D y��i/2Z( �!/t��4 <br /> Sri/v/ - 7 r , rG � I'�- L&!" 2 3 & D O D rm <br /> 6. ,1 7rJ''ct S :S-� $ m x T. <br /> h r� C817/1 cc r5 svl lo�sl� CD C- y o 3 <br /> 7. m u N , A <br /> I declare that this application (including any accompanying s edule) has been examined by me and to the best of my cj c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d v, <br /> a � cn : 5-0all information contained in this application(including any accompanying schedule)and I further declare that I recognize �' fD o : o <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 have access to the above described premises at any reasonable time for the purpose of inspection. (D ? <br /> M o : <br /> m m <br /> SIGN HER <br /> a : <br /> 1.1unatuciFof owner or ui ing t r / (date) <br /> ZONING ADMINISTRATOR <br /> vi fA <br /> (A d/fA W N <br /> N CT N N O O <br /> (ll O(T UOO <br /> TOWNSHI PERMITS MAY BE REQUIRED <br />