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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 /> r <br /> m o O <br /> OWNER G£l <br /> TELEPHONE 7I�—,29 q m_ U <br /> MAILING ADDRESSv/ B�X '2 2 G'- C FO z L��1 �1��2� 0 <br /> I L r N � <br /> PROPERTY ADDRESS Z q q y 5-- .Al-rA� V y C- „RO t <br /> F D/l_ gAY f,/ \) c � Q� <br /> LEGAL DESCRIPTION(see tax receipt) c,'3� /'7`/2// � Q/4 A- <br /> DWELLING/BUILDING � GARAGE/ACCESSORYSTRIIC"TURE ❑ ADDITION ❑ lav j szhl— <br /> TYPE OF PERMIT(S): a <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: C F}h�� N o <br /> 3 <br /> '/T y (LHome/�Cyabin;I�Cjo7m-mercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: V.-{. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NS)AND INDICATE c m A <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m C, 3-11 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. 1 J <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 /> o 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE C VERIFICATION MAY BE DONE WHEN o "r <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1 <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. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M cc Wd0M Daim <br /> 6. 9 0 N C y N O 7' 3 <br /> 7. Z C N N O O 10 <br /> O N Tom ' m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — �' ' O <br /> PP ( 9 Y 1 Y y c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize [ M m <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. 1 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 administeri o ther ,o <br /> authorized person to have access to the above describ d premises at any reaso r s 'on. `s <br /> T n <br /> J U D i <br /> SIGN HERE <br /> (signet o caner orb dd g contractor) ` ,( (� 0 <br /> ZONING ADMINISTRATOR ZUU <br /> "O-Y', tion e 4 $� RURNETT COUNT ! <br /> O O N N W W N O <br /> TOWNSHIP PERMITS MAYBE REQUIRED' 7� u O u u o <br /> 6`j S5`� �� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE G <br />