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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 . <br /> r <br /> o QN <br /> q C <br /> OWNER �44 3ni j US TELEPHONE 1.3 s' .Cd ( a� o �\- J <br /> MAILING ADDRESS daO—1 Horne1)wiop' Rd tOPR141 f179 551'"PI — w o <br /> �j oa�310-©i- I ea o <br /> PROPERTY ADDRESS ([w 1G DTI S Z� (��l G E(,e'U <br /> a <br /> � T <br /> p �j 1 <br /> LEGAL DESCRIPTION(see tax receipt) 1'GL a GQI)Go 5 b– O "R%V tJ L C Tl m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn O <br /> TYPE OF PERMIT(S): a <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ '. <br /> STRUCTURE/ADDITION USE: 0nPe, 0 1 <br /> (Home/Cabin; Commercial Business; Bedroom, Deck; etc.) U) C-J <br /> BUILDING CONTRACTOR: P1 l t'SDW <br /> V <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 "1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> T � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(N8)AND INDICATE <br /> C n� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m �7 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK JOHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <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, J N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, HTC.,THE PLANS ° 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY Bfa DONE WHEN – 0 <br /> NEEDED. 0 <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: ('C' <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. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X co01— D0D0 V <br /> CD C W 0 M of m <br /> 6. rD 0xB nm xn D <br /> =m C ^ o n 3 <br /> 7. Z C m 0 i 7 =i0 <br /> =— m m <br /> I declare that this application (including an accompanyingschedule has been examined b me and o the best of m O <br /> pP ( 9 Y ) Y Y t7� C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detai,and accuracy of w c_ <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize m my <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 thisi information I am E m ' o <br /> providing in this applic4lion. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ha access to the above described premises at any reasonable time for the purpose of inspection. m a <br /> 9 -n <br /> k � a : <br /> v9 _a <br /> SIGN HERE <br /> J:re re of owne r ilding contractor) (date) o <br /> ZONING ADMINISTRATOR64 64 <br /> V En u <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> G OCn O N N01 (nO <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Wim.+- 4-.Ie-f4-C.r q-ta,W �v AWfso , 10-9-'()6 <br />