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Burnett County 7410 Co.Rd. K,No.102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> i r <br /> OWNER Dh i O Y• 1 vL TELEPHONE 6.,�� — _ 7 J 3 w <br /> m tom, <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS g a � D 6L <br /> LEGAL DESCRIPTION(see tax receipt) Let If t of and f c r er 1317►n 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE �z ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CL <br /> STRUCTURE/ADDITIONUSE: L�'-)CKAL-L—. C1.,4 {tel cxkc_ 0 <br /> (Ho a/Cabin;Commercial Business; Bedroom; Deck;etc.) W �^ <br /> � <br /> y�^ <br /> BUILDING CONTRACTOR: �7(/—^+�eN\t,'' F_� � w <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n O. <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �" <br /> NORTH(N). <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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 /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI g <br /> NEEDED. P 'nom <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 4P#J n / ; o <br /> CONDITIONS OF PERMIT: p��/"//►► tJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF ERNMI e7-rISSUANCE. CO <br /> I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINEZON/^G N, <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 /> SF <br /> TBACK AREA. <br /> 5zu /-� C�CC�-tc��Y�� �d C�rtdan�rzc ' <br /> 7] Om 0 vD0 'o <br /> 6. ne m 3o � xa� � <br /> N C 0 m O = M <br /> 7. Z nNry0 : :3 <br /> o T i M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to best of m ' `: O <br /> PP (� 9 Y ) Y Y 0 2 : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of w : Na <br /> m <br /> C i 0 • <br /> all information contained in this application(including any accompanying schedule)and I further declare O.at I recognize m � o mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD '. <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this inf rmation I am w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m o <br /> d m m <br /> SIGN HERE D Zd <br /> (signature of ow building contract r) \ (date) o. i <br /> M :U.11 <br /> ZONING /ADMINISTRATOR <br /> An-V 4V (A Eh EH N <br /> Y ' IISS✓✓ N CT N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br /> _4 <br /> Te �lQ 811 <br /> ,Yl � <br /> HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANC57-q-U� <br /> G <br />