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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> /yC� ani <br /> n -r ` , /y w�`� TELE HON( S,�� <br /> OWNER /7 I4n J4i1.'Ge N -'e_d1 �C�IQ/ p <br /> y <br /> HOME ADDRESS dt� f7� .�/rA le /ISO f� An Ay y � L T <br /> y ,p <br /> EMERGENCY/FIRE NUMBER yo�z ROAD NAME ej 4,re 404 / <br /> LEGAL DESCRIPTION(see tax receipt) Pa, Vo/4M1C Y yol !9. ,2 Yfj SQGt,'oA 11 i/y, TyMilt?lfW <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE �I ADDITION ❑ PRIVY ❑ T�a'�1 rn oma' <br /> TYPE OF PERMIT(S): G>t �C <br /> CT <br /> FILLING/GRA/DING El CAMPING UNIT F-1SUBDIVISIONE] Tat.h4f4 c, <br /> STRUCTURE/ADDITION USE: t,7 ar4,.e — 5100r4 fe `- <br /> o' <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) m <br /> 41 <br /> BUILDING CONTRACTOR: C 4 1714; /41A vrp. (igen to CG fe <br /> v <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. m =. <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 a <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. v l <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <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 <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT NN 1 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X 'O0r- oov <br /> 6. 3 cL <br /> • E c m . 0' = F <br /> 7. Z y � o _� <br /> o <br /> ern. m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize v m m m <br /> that this Information 1 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_C �a/��.g� r art tht nformation I am <br /> providing in this application. I agree to permit county officials char =rdm= <br /> jdfe�ip ul��Q�ll antes or other E m f <br /> authorized person to have access to the above described premises of fie flmeo he perp . e,of inspection. <br /> r 8 <br /> SIGN HERE 6 <br /> (signature of owner or building contractor) 22 ) <br /> ZONING ADMINISTRATOR L)m T I�YIl niIR,I µ ! CoJ(-g <br /> ZONING n <br /> E <br /> VN ,[NT O ,(NT fNlOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />