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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 l7 Z <br /> APPLICATION FOR LAND USE PERMITS _3_ <br /> r <br /> y O <br /> N <br /> C <br /> OWNER <br /> v \ TELEPHONE70/ na L � �� S <br /> d <br /> MAILING ADDRESS \/LJ 10 C5 a —7 , 1 <br /> de A . c , FaIIS �t01 <br /> PROPERTY ADDRESS <br /> 30o8'D 5l\awi� r, 4v". bkry Lul <br /> LEGAL DESCRIPTION(see tax receipt) 5 `7 7 y 2 S W --ql —/S- 7-S- c p <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 7 ADDITION c 0 <br /> TYPE OF PERMIT(S): l71 c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> C '1 < <br /> STRUCTURE/ADDITION USE: G Ol 2 e- b b -- :Sc-V'c-2.Y\� 1� -q Q i A�s-+ M {,J ect <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn J <br /> m <br /> 1� <br /> BUILDING CONTRACTOR: 5ew <br /> v <br /> W N <br /> A PLOT PLAN MUST 8E PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A ��r T ' <br /> �� IO U O � <br /> /��� 0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �i1„/J 4 �, p a <br /> l� Tt <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <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)70 ALL LOT LINES,(B)BUILDING(S)TO m o03 <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO l/1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. ' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> rl., CA <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS b (1 , <br /> MUST BE SIGNED AND DATED BY THE OWNER. XJ <br /> `f� I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 1'a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z CA o Q <br /> ^ <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT („ <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 QD <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. C1, bt l�rtof� <br /> _ �1� �A L M C W S 0 M n * M <br /> 6. —f°I'L2e D L Al T L—f m. x B a m x a <br /> 7. o <br /> O m i all m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m �j O <br /> PP ( 9 Y ) Y Y <br /> J : <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of d i C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D int <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 0 o ; <br /> providing in this application. I agree to permit count officials charged with administering count ordinances or other ' <br /> P 9 PP� 9 P Y 9 9 Y <br /> authorized pers ave access to the above described premises at any reaso goWti obi *pe tion. 'D <br /> _ -n a , <br /> SIGN HERE <br /> (si atu of owner Iding contractor) (date) o <br /> ZONING ADMINISTRATOR SEP 8 2005 <br /> G �fAEAfAEA�N <br /> TOWNSHIP PERMITS MAY BE REQUIREJRNETT COUNTY /� <br /> THIS PERMIT XI2- �r Ytfl'lR F VO�9Ink 4-/ ^V'U �t�q - <br />