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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 /> r <br /> N O <br /> N <br /> OWNER G M S Ke TELEPHONE ?G 3 _Y-2s-- 70 <br /> MAILING ADDRESS )?O021) AVe PfyO,7 &)( h MN S'�5 <br /> PROPERTYADDRESS PO , Rd, 1 0 <br /> 9✓ <br /> LEGAL DESCRIPTION(see tax receipt) L6t7 a3 14�ajohouo Lx& 00 <br /> CD <br /> IIppII <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ O (n o <br /> TYPE OF PERMIT(S): p , a <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> ❑ ❑ � � � <br /> STRUCTURE/ADDITIONOSE: SU VISIONj tV 41 r, /-�'�`t <br /> 0 <br /> (Home/Cabin; Comm al Business;Bedroom; De ;etc.) <br /> t � <br /> BUILDING CONTRACTOR: Ti Gt iZ <br /> 9! 45 RUC }/ O-el <br /> v <br /> m <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 /> N ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m v <br /> TI a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 90 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). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <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. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. pb <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �U <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ,y j <br /> n� .✓tip m obi � 0 M a * rail <br /> 30Ma � <br /> a m � ;u <br /> v m C y o 3 <br /> Z w m o <br /> o Tom : M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (n� ,, — IJ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ALJ m n .n C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize gyp; m o 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 information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> CD m <br /> SIGN HERE 4"-1,2p1p _ <br /> (signa e o owner or in ontractor) (date) a <br /> ZONING ADMINISTRATOR <br /> Efl fA EA EA � N <br /> CT O U T <br /> TOWNSHIP PERMITS MAY BE REQUIRED O O <br />