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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. SLS <br /> y O <br /> Ul <br /> C <br /> 'T ,//�/ L(T 1/�y�7 fD <br /> OWNER AAMMDNO V , EAM16#77[6I// TELEPHONE 7 <br /> MAILING ADDRESS :QX Y I j LH A 1Vr, PAUL,AJ/1/ J3 <br /> '109-tslo/ r O <br /> PROPERTYADDRESS NW o <br /> /1 ` I/ o //n (( cn <br /> LEGAL DESCRIPTION(see tax receipt) GL 3 L� �Sf1 !1a / 3S `''_ T o <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑/CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USE: 6 A K A Gir a ab <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: M e25-9— 39 d <br /> og8 830 2 -� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p Q <br /> ;U N p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT M �J y <br /> ?t O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 3 <br /> v <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. P <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o O� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONtRA07QR,ETC,THE PLANS 0 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. J� <br /> 3'µm;°�`/��' I ��`" O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY tte'a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �/r f o >r'' <br /> CONDITIONS OF PERMIT: �, V <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIF�C)��/GIi? `r <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER ) <br /> SETBACK AREA. <br /> 5. <br /> m m rrDi 0Da 17 � <br /> w <br /> 6. �' <br /> 3 'am � � m ,my <br /> '6 N C y 0 O � 3 <br /> O <br /> 7. O 'Q M m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W 0 in <br /> Q. E : v, : 55 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O : 0 <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> m : m: <br /> authorized person to have access to the above scribed premises at any reasonable time for the purpose of inspection. o <br /> In SGT � 07�� <br /> SIGN HERE i 0- : <br /> (signature of o er or building contractor) (date) <br /> ZONING ADM STRATOR \11 1C1 fA <br /> N N N O O <br /> V N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />