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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 /> N <br /> ,f C <br /> OWNER l(IIA Yti J- pE'ARrf o N TELEPHONE 763 — 74 z — n <br /> o <br /> m <br /> m <br /> MAILINGADDRESS 23 3371' ,2 - A16. r. /KN j—j-'0o8 ° <br /> 0 <br /> i <br /> PROPERTY ADDRESS a 7837 Cf� <br /> LEGAL DESCRIPTION(see tax receipt) 2L f6N 2-8T40N 9(54) ClQAr dK Accts 4-7-7 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION tA (n o <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> / / <br /> STRUCTURE/ADDITION USE: CA 6%N Po 1^G — enC1oscQ' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) w <br /> 7� m <br /> BUILDING CONTRACTOR: C b U� a <br /> v <br /> m � <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. In = '� G <br /> rZI m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). (A \ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)T m 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a 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. <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. F <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WIEN o <br /> NEEDED. <br /> 4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a <br /> ISSUANCE. ➢J Q <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. IN <br /> 5. Dl <br /> f.� M Cy m n ' D 0 '0 <br /> 6. n >)c a ca m n O�c a2. m <br /> m - 3 <br /> 7. 0 cino � Z -� <br /> o m ? A <br /> = � [ i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acc iracy of C) m n r" <br /> all information contained in this application (including any accompanying schedule)and I further declare that I re ognize m c : a mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to is- <br /> Q : s : <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this informat on I am m : o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances r other j <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insl iection. m a <br /> SIGN HERE \ /G>,r.— <br /> (signature of owne r building contractor) (date) S ' o <br /> ZONING ADMINISTRATOR —1I7n <br /> ER fA 63M� N <br /> O N (I W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE-9F ISSUANCE <br /> �m�-� d- le-iM- matte +o W,iteat7.) oh 8-ILI'IY2 <br />