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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator @ o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> N <br /> OWNER 2K J N S' TELEPHONE <br /> MAILINGADDRESS ZCt2 tnt/LST Dmf AsAocr L� IVy _ D/}�/�4 lt/L SLfB3v O <br /> 0 m <br /> PROPERTYADDRESS a907-2, (,l y <br /> LEGAL DESCRIPTION(see tax receipt) I—OT15 F LAJF5 (,(MODS,bC TN7-1k W9- SiC n7 r m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE R] ADDITION ❑ 7•XW yO 0 <br /> TYPE OF PERMIT(S): /y 1 Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: GAah4a ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> �I _ 6/6 '-070 <br /> y>c v <br /> BUILDING CONTRACTOR: W�LT(�R ��, ��It/Sl. (o —0 70/ w <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 (0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p n I'n O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (� O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C I� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mV ' 3 <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. P <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. p .. <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 ° C�O <br /> MUST BE SIGNED AND DATED BY THE OWNER. o �p <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° J <br /> NEEDED. L/} <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o tC` <br /> CONDITIONS OF PERMIT: v (7 N <br /> d � <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. G <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC.. ALLOWED WITHIN THE RE0L11RFn WATFR <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> Z7 co 0C: 01 00ODov <br /> 6. habitation. 0 = 3 n ID a m <br /> N x <br /> 'o pmcy .`" o � � <br /> 7. Z cin m o <br /> v : m <br /> I declare that this application (including auy accompenymg scneume) nas oeen exammea by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ` m ' M <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m : cn <br /> G) : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing In this application. I agree to ermi count officials charged with administeri count i ther <br /> P 9 PP 9 P Y 9 <br /> authorized person to h ve access to b e escribed premises at any reas naID <br /> s on. n <br /> CD D <br /> SIGN HERE v <br /> CD a <br /> of owner or building contractor) date : 0 <br /> APR 2 1 <br /> ZONING ADMINISTRATOR <br /> �00� <br /> v�t» <br /> +09'7'701Jcouf, a �� 6URNETT COUNTY C)8N W w <br /> TOWNSHIP PERMITS MAY BE REQUIRED6gNf& <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSG <br /> CE <br />