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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 �. <br /> /65-7 N <br /> OWNER S0� TELEPHONE 7/5 S <br /> / m <br /> MAILING ADDRESS SAn1 �. <br /> �» m <br /> PROPERTY ADDRESS &SS LK �d <br /> Lb 1 D"/ Y VV 1, <br /> LEGAL DESCRIPTION(see tax receipt) �i?Y (� 57EC7/ /Y 3 j IG <br /> DWELLING/BUILDINGA GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ U7 0 <br /> TYPE OF PERMIT(S): Ur <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: AWM10bld <br /> (Home/Ca in;Com ercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: F—`G S � �i / �1SAL <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. i )_ Qyv O y wp <br /> M N —J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 w jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. pp <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2 (�) <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> O Z <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF o <br /> NEEDED. <br /> lit <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. my Z <br /> Jur, <br /> CONDITIONS OF PERMIT: 14 <br /> p 4 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P B'&fNETrQ <br /> ISSUANCE. ZO COUN <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NTNG Ty <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. NeW tf, eOC& <br /> S <br /> 00000 m W 0 9 f m <br /> s. XO/v� J� r Q <br /> 'mo , vorne- 1-0 e- team 73 <br /> om C y O j <br /> II declarers application (including any accompanying schedule) has been examined by me and to the best of my 2S C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm a : ei <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize !E m oo ` m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �*^: m <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 E m E E <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. a ' o <br /> SIGN HERE (n '`7— 62 <br /> (sin f owner or it g contractor) (date) o <br /> %ING ADMIN STRATOR <br /> UtO Vt � OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �'� "iHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />