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Burnett County 7410 Co. Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator "Z D 2 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> o <br /> /J/, -2-7� 7OWNER /n/A l / / /Qn0/ S TELEPHON0 c <br /> �ID <br /> MAILING ADDRESS <br /> "'7514 f. LI'or <br /> �, �J �f Q q Q o <br /> PROPERTY ADDRESS 3 J6 n l L S 7 O/r 44 1 (�e bSf„e/^ &&:f- SJ 8 1 3 t <br /> J /� /y�J ' /�J- yet / � e <br /> LEGAL DESCRIPTION(see tax receipt) n0 T 3 ` s, " / Y �� / / 3� O cn <br /> O � � <br /> DWELLINGIBUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (n <br /> TYPE OF PERMIT(S): it <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: 51-OtL/� 6 E CJI ��r °. <br /> (Home/Cabin; G4afmmercial Business; Bedroom; Deck; etc.) vl <br /> .SEL r` <br /> BUILDING CONTRACTOR: '' ^^ <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O y � Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In a ✓� <br /> NORTH(N). No <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 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. 9 <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. o (`jq <br /> p � 1 <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: I <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT y <br /> ISSUANCE. C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ow <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 0 <br /> PERMITTED. 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. St�/lSIKAREA. 'v� 1 �1 �i e <br /> a o s;d� yar r M. 11101— > 0 > 0 -0 <br /> C m c m d 00 n f m <br /> 6. 5 m x3CO <br /> nm m� nm A <br /> Z crnmo <br /> 7. o m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — r^ : O <br /> PP ( 9 Y ) Y Y G) C - ; <br /> fi _ C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a) r0i C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 m 0 <br /> providing in this application. 1 agree to permit county officials charged with ad r' nt ordinancespro ther m <br /> authorized per! v access to the above described premises at any rea r p r f c 'on. ° o <br /> -n <br /> D <br /> SIGN H E <br /> (signature of owner or building contractor) (date) i 0 <br /> OCT <br /> ZONING ADMINISTRATOR <br /> ; 2004 <br /> BURNETT COUNTYTOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSTJANCEC' <br />