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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. &3 <br /> r O <br /> N 0 <br /> T' /1 1 pro - -ass--,75 <br /> OWNER i r e j and �J O V til nLrrl�`l.I TELEPHONE 7 4i <br /> m <br /> T <br /> MAILING ADDRESS I <br /> I�q ] TVVV�2CI St K) U0 f�ndWe,� M1U 5530 v 0 <br /> y r <br /> 0 <br /> PROPERTYADDRESS <br /> Z17-17 573j/&'j-5' 9321jz4 9Z5/7j•7/1,181V AGtjES 1, Z30 e <br /> LEGAL DESCRIPTION(see tax receipt)z V 9 P-71 T N e70V <br /> OT3 � �l <br /> eg0 <br /> (2F S19 ✓ b t' 23Y� �� //�� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ "1 U) o <br /> TYPE OF PERMIT(S): Q <br /> FILLIN/G//GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: C�{Y�,� o (} <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) SCJ <br /> v <br /> BUILDING CONTRACTOR:C7�pCQ <br /> -�- -U <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T �i <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. jj <br /> O _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Inm <br /> -n c <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m J <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 003 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS a 0 r` <br /> MUST BE SIGNED AND DATED BY THE OWNER. l/1 o )T <br /> -7 <br /> NEEDED. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN "» �1 <br /> NEEDED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: A <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> � I <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 \I"l <br /> SETBACK AREA. __//---- <br /> 5. ons;4e fit- 60, 1 <br /> C1 C W M a : M <br /> CD c m n m a F m <br /> 6. m m 'am O� �' � <br /> o m cN o 3 <br /> 7. <br /> Z cm � 0 <br /> o m stn : M <br /> — (nm <br /> I declare that this application (including any accompanying schedule) hasbeen exa I c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am resp I c f d n <br /> all information contained in this application(including any accompanying schedule) I urther der are t at recogni m c m <br /> that this information I am providing will be relied upon by the County of Burnett WISP sin in determining whether to D o) <br /> sue a permit. I further accept all liability which may be a result of the County of Bu relying rr�f on 1 m : o <br /> providing in this application. I agree to permit county officials charged with admi i ing ctiuhty oTdiffarTce"s or of er n <br /> authorized person to have access to the above described premises at any reasonabie i f o `ID n <br /> m > : <br /> SIGN HERE -FFn <br /> v> n <br /> V 11 <br /> (s' n(t'uurr�tcon <br /> e of wner or bui ing tracto ) ■y (datey) 0 <br /> ZONING ADMINISTRATOR ( Vl NA <br /> NETT COUNTY O N G J J N O <br /> TOWNSHIP PERMITS MAYBE REQUIRED BUR <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAR&NI <br /> 6-re5f�G��ctPpe�Iy 6-1` <br />