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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 <br /> c <br /> �t <br /> m <br /> OWNER GARq THI LL NWOL Yv1 QAVS TELEPHONE <br /> MAILINGADDRESS 3 �� Cf.A)1l-tz c Iu t- 1) dAVA) I-I $ <br /> PROPERTY ADDRESS ZS-80 <br /> L Ou2t 1 G14WP+!J <br /> �T <br /> LEGAL DESCRIPTION(see lax receipt) ), c, T f 9, l` S � �w <br /> �r <br /> DWELLINGIBUILDING ® C DDITION ❑ N O <br /> TYPE OF PERMIT(S): V Q <br /> FILLING/GRADING ❑ CAMPINGVUNIT ❑ SU DIVISION ❑ a <br /> STRUCTURE/ADDITION USE: } ' L rhe 3 o f T�(© t l✓L 10, �O� y� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> C',BUILDING CONTRACTOR: �C%I I�Otti SSS ^ � <br /> m ^0. <br /> 4l <br /> v p <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n <br /> A _A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). o <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m R�� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF U Z <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 1 Q <br /> BUILDINGS, ROADS, LAKE,LOT LINES. p <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 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. E <br /> O 0 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � 0 �V <br /> NEEDED. ! <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z P I �l t <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> N C N m n MO o f m <br /> 6. m x3 & mOO � A <br /> 'o omc7. <br /> N `.' o � 3 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — O <br /> PP (� 9 Y ) Y Y <br /> nc � ? C <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 E m E 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 InforI am d <br /> mation o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E <br /> authorized person to have access a above described premises at any reasonable time for the purpose of inspection. <br /> T n : <br /> y i <br /> n : <br /> SIGN HERE 0 0 sv n <br /> (sig azure of owner or building contractor) (date) i <br /> ZONING ADMINISTRATOR (r �/ n( Qy <br /> (l d€ <br /> O NN W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v, O u v u o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR.FROM DATE OF ISSUANC <br /> lF=iann� �Ca�us S l J-n-c <br />