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Burnett County 7410 Co.Rd. K,No. 102,Siren,W154872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> OWNER f I I C AAEL r C:NC- 5C,,ALi LrZ' TELEPHONE 6. 1— 7l?" !173 ! l <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 7156® 'j4(,4V, t 0 tjL Q ^� r�L T�(s ice'() i'7�S 1 w<sI SLO11f3 a <br /> ( p) �� TwP Ifo /L i 5 LC)7�-{3 ' <br /> LEGAL DESCRIPTION see tax recei t <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 110 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION El <br /> STRUCTURE/ADDITIONUSE: �UJJ YwJ1L D,j bEeK o <br /> I <br /> (Home/C/a�bi_n; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: YTA44cv'W <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. o <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> m a <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m :b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m y � 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 1 :E <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. NDJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN w g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p <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 /> 6. M m"oaFm <br /> n 3 no tai o.m <br /> v mcg o_ = � <br /> 7, ,oZ a it rc =1 <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my �j E A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofw o ; v, C <br /> o." : u, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D • 3I <br /> o ; M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- ['� <br /> 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 psi M <br /> providing in this ap 'cation. I agree to permit county officials charge 'h ty� rdfianees or other �! m : `• <br /> authorized perso o ave acc th scribed premises at 1 b of inspection. m W <br /> n o <br /> CD <br /> SIGN HERE m `D <br /> — � I d E <br /> (signature of owner or building contractor] i <br /> AUG .-.. 4 2004 <br /> ZONING ADMINISTRATOR `l I {'y <br /> lid fv BURNETT COUNW3;� /7Nf N in N N O O <br /> TOWNSHIP PERMITS MAY BE REOUIR <br /> ENING <br /> P/q� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Q <br />