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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNERGLh TELEPHONE j&-5—!j 6C— ��C..t��q. � e ^S� <br /> m <br /> MAILING ADDRESS C)Z S CIL),/6,447. L/�f PLYMOL., Al A/ SSLf (� v, on <br /> r <br /> O <br /> PROPERTY ADDRESS A ("JED <br /> ►►�� T �./ /� a <br /> LEGAL DESCRIPTION(see tax receipt) !Lf SW VGf SCLtjO✓1 lxtxJY\Sill �(! '`Q v1 Q, ��� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ �� o <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADIN�G/❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: HoM 0 <br /> I/ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: &4-t tq as Owyt CO✓1 f' itL7Li✓ —' ' <br /> m <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 31 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O 0 d <br /> T <br /> ?l O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 w jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In 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. P <br /> 9 <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. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER, TRACTOR, ETC THE PLANS C <br /> MUST BE SIGNED AND DATED BY THE OWNER. � --i �O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE FI h c�� W,HSN 5;' 0 <br /> NEEDED. (vr i 5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. A14y2 p n,w(!(/¢ ;I o <br /> CONDITIONS OF PERMIT: [ i <br /> BUR �y,�t Vnn ,, t• ` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERT/ ► tiQ ]CJ W w <br /> ISSUANCE. CpNfNG �71' t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> S' FATBACK AREA. p <br /> 5. I�I�(/,(�,]) �� � � �/ a g - a/0Od� y Se6QCk077 �I/U2Y� <br /> m ens m 0m a F M6. m 3 nm % D <br /> /,/—�J 11 �/�p /J� m C <br /> 7. v II \S J � Z in T O O t0 m <br /> O G 31 <br /> I declare that this application i ludin an accompanyingschedule has been examined b me and to the best of m —rn: ' O <br /> PP (� 9 Y ) Y Y Gv7� � ' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of f i 220 S9 C <br /> a& : u+ ; :0all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o , m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- :m <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD mi <br /> SIGN HERE S fA C <br /> (signature of owner or buildl <br /> s n actor) (dal a <br /> ZONING ADMINISTRATOR M c � <br /> EA0 ro ro0N <br /> tl e c� TOWNSHIP PERMITS MAY BE REQUIRED N 0 N � 0 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Q <br />