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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator M 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> o <br /> N <br /> C <br /> _ t a N <br /> OWNER &AW," Le-1-t Z.1CC ft <br /> TELEPHONE I�`2U� ZOO I p j <br /> �^ �jOMEfZ SET Ltd l S�IDZS fd/' J) <br /> MAILING ADDRESS 55-1 S o M t_n C E T LA ill E • � <br /> r � <br /> 1/ Q 0 <br /> PROPERTY ADDRESS Zg3 M� l Ili7Jt RD �POota c. � v01 ^ <br /> FA%CTs' o t~ t".r S 1's L 14 ,1 S -i- 16 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Byo(JL Nhc1�L^A1ylE LAKE S►i►° D7V►SJb/J <br /> U N6T1 <br /> DWELLINGIBUILDINGX GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Ij a <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ N� <br /> N � <br /> STRUCTURE/ADDITION USE: 4o me oe� <br /> Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: I L>r E111 .- -% 1 D �,14s% Q <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 a <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> ;a T <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n m <br /> -n + Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <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. <br /> 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. Iv <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER, CONTRACTOR, ETC.,THE PLANS 1 I I �, <br /> MUST BE SIGNED AND DATED BY THE OWNER. V <br /> v <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: Qj <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. J� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. V ?6je' <br /> o > v v v <br /> uJ �q !_ ; r, a <br /> 3 am xft- m ;U <br /> 6. N N y N 5 9 <br /> Z N O <br /> 7. O -n`� m <br /> _c': A <br /> 1 declare that this application(including any accompanying schedule) has been examined by me and to the best of my G) , <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o ' '0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : m my <br /> that this information I am providing will be relied upon by the County of Burnett Wiscons ming whether to is- <br /> d . <br /> sue a permit. I further accept all liabilitywhich may be a result of <br /> I is information I am m <br /> providing in this applic 'on. I agree to permit county officials c t let die of i s e other o <br /> m (n : <br /> authorized person to h a ess tot a above described premis s I for a ose of inspection. - o <br /> CD <br /> 2 5 2003/g - <br /> D� <br /> SIGN HEREn <br /> (signature <br /> �of owner building contracto) (date) <br /> ZONING ADMINISTRATOR �J 1(n i t' B NETT COUNTY <br /> !� rfl <br /> 1 NIM "EA "(A 0 N <br /> �yIV IIV� N 0 N N O O <br /> (n O U (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />