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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 /> UT <br /> S'/- 7Y04 - ouo ldt <br /> OWNER $e I.4AT f� µ h r� TELEPHONE sl 633 47' /1. v <br /> dr m <br /> m <br /> MAILING ADDRESS Q n r v O <br /> d y woo d(cl U�-+-gAiLL t the L-A-W5 /NA) SSDI t f <br /> 0 <br /> (� 0 <br /> PROPERTY ADDRESS 31 -fie-.*,KA S Ara C q(d 1 <br /> LEGAL DESCRIPTION(see tax receipt) t 9 t>lA< L-aw 0 S �+Q�S� ( C/) <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION !n <br /> TYPE OF PERMIT(S): `v <br /> FILLING/GRADING ❑n 'CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITIONUSE: i�tCJ� P'0- P'&-VV W Ito/ <br /> o' <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 42 <br /> s m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> '-I v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 3u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. 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. <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. E <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <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 �U <br /> PERMITTED. r 7 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X m <br /> r- 0 > 010 <br /> m <br /> 6. 3n m x m <br /> (gyp C <br /> 7. Z w N O : 1 <br /> O G M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myG) - <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o, C : v, <br /> C v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o . mM . y <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> SIGN HERE 13 <br /> ,�-�� 03 <br /> (signature f owne or building contractor) (date) n <br /> �� <br /> ZONING ADMINISTRATOR �J I 1 <br /> 169 <br /> Ut O Ut N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />