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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -D 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 1 ti O <br /> OWNER �Q.t/'l� Vt r-+ t y\LOQ Ke-(6 TELEPHONE T 3 2_3 7d e •..�� <br /> °2.t Sif7 h of t,ae s r WT \f Lt �) <br /> MAILING ADDRESS I O <br /> f <br /> PROPERTY ADDRESS 24 Z-q 7 Ga_A+ev\ Pb w i' 2d <br /> LEGALPTION(see tax recipt) <br /> c <br /> -- DESCRIe__—tel L CL_ 17 y - ,38'-IS <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 11 ADDITION o t'-- <br /> TYPE OF PERMIT(S): ,N� c J <br /> FILLING/GRADING ❑ CAMPING UNIT LI SUBDIVISION L1 � crcr <br /> ff I ' < <br /> STRUCTURE/ADDITION USE: I4o me ag 6,eA pprp,-, ty� )aQseAyR c,7_ % 17- a <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: Sr'icuh me. Tz Y\ <br /> v <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 3 <br /> ON W <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I <br /> m m <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 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. 1 0 <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. �i <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS O ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o XJ <br /> NEEDED. m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zj I <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 91 <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. x C.7t' t-riotvt,S ICJ t`el1A 3 Tl Do O r D D O <br /> 6. c d d 0 m o F m <br /> m x D & ;0 <br /> p <br /> N C y y 0 — <br /> 7' Z c in O <br /> o CD m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cn A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> V.J <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ' <br /> v m <br /> authorized person ave access to the above described premises at any reasonable time for the purpose of inspection. D <br /> _ nm <br /> SIGN HERE lJ� 6 6 <br /> (signature of owner orto Iding contractor) ( te) o <br /> 0 <br /> ZONING ADMINISTRATOR y 1 m �I <br /> fA EA EA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED `f <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM D T OF SUANC <br /> arm i+ ,�- 1"0-1 �.� aa�&i I taP o Da aI <br />