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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator o° o <br /> APPLICATION FOR LAND USE PERMITS y a <br /> N <br /> Kern �n � /►'��r9afe'f �,�� a e <br /> OWNER e n n I r C TELEPI ZONE_S-6 _(c S o <br /> 0 <br /> MAILINGADDRESS �JJL —r Umerry ����� /Vat Ifie ld� �nN SSa-5 <br /> i 1 <br /> PROPERTY ADDRESS :3 G7 a"z yfiQ dq(^d LQ�t NOidcr �W <br /> VOIC-A SbOf363 54po 3(C 5351?YO IRMAcres 3,21 <br /> �/ a toboo CC ' 3 P ? 4A <br /> LEGAL DESCRIPTION(see tax receipt) ,;,) j�&"AV4I}moi pl^ L19��,5 Ofo i+.e6 a N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ c Q--. <br /> a <br /> TYPE OF PERMIT(S): Ike ck 0 � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ q �/+�. )O� �. <br /> fly ION y <br /> STRUCTURE/ADDITION USE: U <br /> (Home/ abin;Commercial Business; Bedroom; Deck; etc.) la�drny U' L21 <br /> BUILDING CONTRACTOR: E'O(�j1Z f h e ►o 1 U; we eke W 42 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O a r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m w 77 <br /> m �" <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � I <br /> NEEDED. <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITI DNS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 9 n r D D O V <br /> CD WM0CDafm <br /> ,D dam �c » mom <br /> 6. 10D 01 <br /> Tom : m <br /> 7. =rte : <br /> � . i C) <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my 2 : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofJLY�i <br /> a c o m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C <br /> that this information I 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 I am <br /> providing in this application. I agree to permit county officials charged with ad dinanees or other ? m U), <br /> authorized person to have access to the above described premises ata sbh It t as of inspection. .n o <br /> m m : <br /> � r XPi m <br /> SIGN HERE <br /> y, i date) n <br /> (a gnat or owner r building c ntraetor)- APR 1 n 2004 /.' <br /> L \Ali i <br /> I �I i i <br /> ZONING ADM TRA OR En A <br /> +DA01 <br /> COUNf t ricNi ovN }oo <br /> TOWNSHIP PERMITS MAY BE <br /> TT <br /> �J O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM ISSUANCE <br />