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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 ql 3. <br /> Cj'; a2 38 V1 A•JY11�7� <br /> OWNER O� Fio!I) Z e- <br /> TELEPHONE $3 o , V 1 <br /> 1 / O� <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) -S S ZL �_4/e) <br /> DWELLING/BUILDING ❑ G ONSIDE/ACCESSORY STRUCTURE I,Y_J ADDITION ❑ PRIVY ❑ �1N y o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONS.S. <br /> STRUCTURE/ADDITION USE: ap e, zax IL <br /> � <br /> ome/Cabi ; Commercial Business; Bedroom; Mck;etc.) Gn <br /> BUILDING CONTRACTOR: Orl'a/haler- in Ff - /VyrAc)peas &'L'i-a - -5kX4 Ctr,Ke-,�J/ <br /> CDv <br /> CD <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. -n <br /> A n r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO) c <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 <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. 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 o Q$111o � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN cr <br /> ^ o <br /> NEEDED. a � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: I i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q of <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 /,, Q <br /> PERMITTED. V Q✓ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WAyER <br /> SETBACK AREA. <br /> 5. <br /> X11 0 r'-,D �. m � CD mQ rn m <br /> m C N 0 O � <br /> J <br /> 7. <br /> Z N ZM MO <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q B <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the Co f Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result f of Burnett relying on this information I am ; m <br /> providing in this application. I agree to permit county offiGi i q+iuustering county ordinances or other m <br /> authorized person to have access to the above described p ses a I i" or the purpose of inspection. m <br /> �) //' __� m <br /> / t„tivyk Q cn <br /> SIGN HERE '— <br /> Is n ture of owner or b it Ing cont tor) (date) <br /> ZONING ADMINISTRATOR Cf(f w <br /> A' vi fn fn fn cn fn <br /> 2O,vl O/ N Nn P Nn P <br /> CIS CIS O V1 Ut O O <br /> TOWNSHIP PERMITS MAY BE REZHJIRE 0000000 <br />