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U))I cav' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> ir o <br /> OWNER L./�N/cL J Dc-sTAC/YF TELEPHONE 4 S5 yZ ij- a20 c yJ <br /> L �I <br /> HOME ADDRESS -36 /4c ^filly S /T A/ AlrGrn0 AN <br /> Q p o m <br /> EMERGENCY/FIRE NUMBER �� /Jr ROAD NAME RAST <br /> y�y �y/Tvo�R/74� AcRr-s , o <br /> LEGAL DESCRIPTI N(see tax receipt) 407- 3 CSMV/16/ P /l g ��OL/ Lo'f ( � \ iJ�+Cl) <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 1p > �. <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> a�xaA <br /> N <br /> STRUCTURE/ADDITION USE: C�� <br /> (Home/Ca <br /> kk\n;Comm/e��ial Business; Bedroom; Deck;etc.) ca <br /> BUILDING CONTRACTOR: IJAa.' NS7 4C Ae <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ( - / 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 3�,S�S� 6G� o a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. IGl m d � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. "G <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. I `t <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. oC 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. <br /> �1J O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P I I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' <br /> ISSUANCE. ID <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/ w <br /> 5. SETBACK AREA. 'u �� ' t_ Q (t mOUdd <br /> Non, C y-,��1 n v�' C7U IO t�U�?�it c 1 _ <br /> L,(L -LiewA-4 �- W1l�tti 30d 27'hlC / J3"' d m j X m <br /> 6. V �o,� mCNmo ' 3_ <br /> 7. <br /> o : <br /> fir„: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 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 <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize CD C io <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y O <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' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Co <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. ; <br /> m : <br /> m <br /> SIGN HERE <br /> 3 <br /> (sign re o owner r b tractor) (date) <br /> ZONING ADMINISTRATOR <br /> wwM "" <br /> A 110 69 <br /> M M V 1 N N V I N <br /> MfT0(T 000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 9 0 0 0 0 0 0 <br />