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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> gpZoning Administrator <br /> �0r `I <br /> 0PERMITS <br /> :Beo.✓d,LcG1 /77v 0 gJ <br /> OWNER �/ �'�.7oN,y /7eQ,S TELEPHON q_ �Ss-` a Q <br /> /� 7�J <br /> _o <br /> HOME ADDRESS.79316 (,J "Al t !�✓ES m <br /> F1! �A' DAN�urW! J'' C <br /> y�.3a <br /> EMERGENCY/FIRE NUMBER a 9.3/4 rS,oeµ/r/q Prov <br /> ROAD NAME <br /> 3a! •�, si 9y �!9 1d vl z CS � <br /> LEGAL DESCRIPTION(see tax receipt) o�T� 15 [rJ ACRxs !•So0 <br /> God 4d ZL <br /> TYPE OF PERMIT(S): DWELLING/BUI DING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ � y' p�$ C ' <br /> �y t y� .,,( X a <br /> STRUCTURE/ADDITION USE: S7o'rA9E-par T[G �f li1L�e�[�. e!C i — <br /> 0 <br /> (Home/Cabin, Comm rca i Business; Bedroom; Deck;etc.) U ' <br /> BUILDING CONTRACTOR:�ySU /ta <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR ) <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) M <br /> C <br /> n a O <br /> I. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o < Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). <br /> —j--SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. * <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o o <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Iry <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. t1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER _ <br /> SETBACK AREA. <br /> This structure to be used as private residential <br /> 6. garage/storage only. Not to be used for human g < = 8 g a m <br /> habitation. LD. <br /> a (OD " ~ _ <br /> 7. m Cy o' er 3 <br /> 2 : in o o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cn p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <br /> l7 <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 <br /> providing in this application. I agree to permit county officials chargedwith administering county ordinances or other <br /> n to ave ° <br /> uthorized persoaccess to the above described premises at any reasonable time for the purpose of inspection. mD <br /> : <br /> M : <br /> HER m <br /> , _ �O / En <br /> (s' r ner or building co ra or) (date) 5 <br /> ADMINISTRATOR -1 rtw <br /> OWNSHIP PERMITS MAY BE REQUIRED S <br /> p3 <br />