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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> N <br /> � 1 j� C <br /> OWNER ( r C,1'ft c! D (r/7/I e- u y�0 c /\ TELEPHONE 7/5 yy— 355 / <br /> MAILINGADDRESS Pc FX -? liJI 7 yio,ztj <br /> � Q o <br /> PROPERTY ADDRESS ;,7��� mieot CI rC�� f �ah�urY, wl <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �. y <br /> TYPE OF PERMIT(S): <br /> n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> ' � <br /> T. <br /> STRUCTURE/ADDITION USE: 2(Homeb/Cabin; <br /> Commercial Business; Bedroom; Deck; etc.) (D <br /> BUILDING CONTRACTOR: I e• r d C !` b2611 5- Elf f U C' 77-/ V A) —rA, C , m <br /> Q <br /> -o <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> WYs k- 00-0- 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) -n n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 Rtv <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !? <br /> NORTH(N). CCA <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. C <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 1 5. <br /> MUST BE SIGNED AND DATED BY THE OWNER. O(),c5 <br /> — o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N <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 /> Ncm du rDi <br /> n c o <br /> 6. m x o. o <br /> O p N C y <br /> 7. p D y T c <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — m <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application (including any accompanying schedule)and I further declare that 1 recognize (� m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is C <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 : m <br /> providing in this application. I agree to permit count officials charged with administering count ordinances or other a[ <br /> P 9 PP� 9 P Y 9 9 Y � <br /> authorized person to hav cess to the above descri d premises at any reasonable io m <br /> U <br /> U <br /> SIGN HERE <br /> (signature <br /> of owner og r building contractor) (date) j <br /> ZONING ADMINISTRATOR RQV)c n �I�' `-^T 3 2005 "JI : <br /> .Li <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTANG O <br /> THIS PERMIT SHALL EPIR ONE YEAR FR9M DATE OF I Upf <br />