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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 /> 67 <br /> 67 0 <br /> 7q3_� R <br /> OWNER Qi �h (�_ —TELEPHONE / ' 7 0 <br /> MAILINGADDRESS / qS �i '-eld e <br /> CD <br /> m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) � 00ID <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (1 (n 0 <br /> TYPE OF PERMIT(S): 302 3�— Wl <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ J <br /> I 1 r�►rn� -� rew la.� b r,�rne d ani �� N <br /> STRUCTURE/ADDITIONOSE: o <br /> ome/Cabin; Commercial Business; Bedroom; Deck;etc) <br /> BUILDING CONTRACTOR: / ^( <br /> y312 A 96 LIC -lam 83 <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. T <br /> x m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a_ ` r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m < A <br /> NORTH(N). C <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. e (/) 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. / 0 <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, CQNT QR ETC.,THE PLANS ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. J Z��l <br /> 7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIIC ITA ON MA � o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 20� o <br /> CONDITIONS OF PERMIT: B�RC) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIVQN'NlaNET7'COUNTY <br /> ISSUANCE. r V <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. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACKAREA. / q, <br /> 5. Y,./�// y� C� Q�" —�� <br /> 6. <br /> ' 1 OQ CD W <br /> 3 ncD 0, <br /> nm <br /> o DC C " <br /> 7. Z ymo n1 <br /> o T� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m C v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- IU <br /> CD <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I amm <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. fD o <br /> CD m <br /> SIGN HERE <br /> (signatur caner or building contytor) (date) a a <br /> ZONING ADMINISTRATOR <br /> e»F» <br /> G f/iUN OU)0 (Jj00 <br /> E/i fA EA � N <br /> �I� 1 <br /> � <br /> TOWNSHIP PERMITS MAY BE REQUIREDNN N <br /> (A� <br />