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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. rte} <br /> 0- t7 <br /> o <br /> c r�> <br /> m y�VJ^ <br /> OWNER <br /> 61"ek O`A TELEPHONE &SI_ z+g .- zzr7,3 p <br /> m <br /> A O <br /> MAILINGADDRESS (05-71qq ZOSf� 4je- N4u Pry-tGG7>v-� ,/Vl' l, Srnz)-7&7 <br /> r7 // /6WD I � (aru..ks bwrl ( <br /> PROPERTYADDRESS TZSte•"' S •ItpC/ �•"- �'- L,01 34V14,,p 1 <br /> t <br /> LEGAL DESCRIPTION(see tax receipt) 6SM M1 I S 3U -rge H P l✓;,Z ()) m 1 <br /> ," <br /> L#J <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 11 ADDITION ❑ ~v� c a (� <br /> TYPE OF PERMIT(S): Q S <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: H oimL o r ,` <br /> (Home/Cabin; Commer ial Business; Bedroom; Deck; etc.) W <br /> f ! / r ? � <br /> BUILDING CONTRACTOR: ��(L � M or„'l J 0 /O tu a � w <br /> m <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> /Z1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 W 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). W ` 3 <br /> 3 .SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDINGS)TO m <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. P <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. C <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,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. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW" o <br /> CONDITIONS OF PERMIT: <br /> � W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 C) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t Q <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 /> X and u � Ma : m <br /> 6. m x. 3 <br /> pm C rrn u' o <br /> 7. Z I m m o <br /> o <br /> m it'd : <br /> - � ° m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m D <br /> PP ( 9 Y ) Y Y J G> vJ C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m c <br /> that this information 1 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 1 am o <br /> providing in this appli ation. I agree to permit county officials charged with adnces or other T <br /> authorized person to a access to the above described premises at any reason t o ti n. m n <br /> T <br /> m <br /> D <br /> SIGN HERE L Ile, <br /> (s' a re of ow r building contractor) _ (date) o <br /> JUN 2 92085 <br /> ZONING ADMINISTRA OR <br /> in. v e+ <br /> N 469 tA :A <br /> O O <br /> BURNETT COUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �! �1 ZONING <br /> T (M M+ 4- 124- -f Er" Y� F�M DATE <br />