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I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> m O <br /> N ++ <br /> a <br /> OWNER- Roy-V LLJ S TELEPHONE / J1p kj 3 v <br /> MAILINGADDRESS A <br /> r � <br /> PROPERTYADDRESS 4j �o, r O g 3 0 <br /> (\� Lei <br /> LEGAL DESCRIPTION(see tax receipt) •-�.Dp � . I� ��cH � cn (� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 14 ADDITION ❑ I m o <br /> TYPE OF PERMIT(S): O `v <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ (`r a <br /> m' <br /> STRUCTURE/ADDITION USE: r $ <br /> ( e/C bin; Commercial Business;Bedroo , Deck;etc.) rn <br /> BUILDING CONTRACTOR: Ry Ly1 m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). ( <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 v 1 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. `< O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS o 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ^» <br /> NEEDED. c� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. x o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �j I <br /> ISSUANCE. W (ti <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m m r� 0 Da <br /> m <br /> 6. 3n(OD On <br /> 9 N C y N <br /> 7. Z H O -I <br /> O T K M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myp <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d o v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D o m <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. I further accept all "abMwnmcity be a result of the County ofBurnett relying on this information I amproviding in this application. I agreunty officials charged with administering county ordinances or otherauthorized pers ave access to c ibed premises at any reasonable time for the purpose of inspection. `D Cn <br /> CD o : <br /> (D m <br /> SIGN HERE VA �C✓ 3 '��' "� <br /> CL <br /> (sig ture of owner or co c (date) <br /> ZONING ADMINISTRAT <br /> cri<n <br /> EA <br /> LATNN0A fA 0 <br /> NO <br /> NO(T N 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />