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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator -U G0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N <br /> OWNER G/&U G��Mrr4/VAl TELEPHONE ?5;L-93.3- 931-2 o a N <br /> MAILING ADDRESS 7�� // O nw �,A m� SS3[7 p <br /> PROPERTY ADDRESS ;45'7/ 7 S Rj <br /> LEGAL DESCRIPTION see tax receipt) // // �NS �LGLj GSI1'1 G / �� 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE Ll ADDITION ❑ -- — c 3 o rt- <br /> TYPE OF PERMIT(S): � <br /> FILLING/G <br /> �RA <br /> _DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: l (Wr" e C)n l u <br /> J <br /> (Home/C bin, Commercial Business; Bedroom; Deck; etc.) N J <br /> 1m <br /> BUILDING CONTRACTOR: GvAyA�E /1/ta tT �'n n Cf2,rc7�31 <br /> 2 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 3. T Q <br /> DIEJECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) A <br /> ° a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o (a? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m A J <br /> NORTH(N). m n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO to -o <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ( M1 z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. v I <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. 91 :E Q <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. I <br /> J o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. " ° Q <br /> n � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �j y <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t1 <br /> ISSUANCE. h � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J O <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 p ' <br /> SETBACK AREA. <br /> 5. <br /> 6. m �: W y. ODa OM <br /> m 3 nm x 9: <br /> 7. o Oocy3 <br /> Z c N N 00 O i <br /> P m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm C e <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize '9 , m ; ' ' reit <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 informs her <br /> tioI am I d : o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reason b ,action. m f <br /> T a : <br /> D <br /> SIGN HERE <br /> (sin u of ow er or building contractor) (date) <br /> ZONING ADMINISTRATOR 17 ri2007 CEJ <br /> O N (li W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIREDBURNETT COUNTY <br /> THIS PERMIT SHA L XPIRE ONS YFARFROf(A�D�ATE OF I,SS�!IG <br /> f�errni} a lP, - melt " (/J ne ll1u 1 -o"J <br />