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OxC- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y 0 <br /> OWNER 6I pL 1 n.,.l/. TELEPHONE <br /> HOME ADDREVVSSNt�IGL <br /> k(,lk44re- �o� , &I, ivrzf , <br /> EMERGENCY/FIRE NUMBER aff'30 ROAD NAME o <br /> L�r1� <br /> LEGAL DESCRIPTION(see tax receipt) rn <br /> f'f IS /6 //o r� UY/ 9 .� �� <br /> �Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> IqN <br /> STRUCTURE/ADDITION USE: lmextLPek04, AhR <br /> —� (Ho /n; om/mercia us ess; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: //C� �/7tY1 UGf foo a E C <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m jjj A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C o <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. P <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 /> S. 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 0 pb <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. 2 UU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. wR. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. VV <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. J <br /> 6. 1 f1Zvn Ipa Prl� V�QC� ih¢h ctif S C3 � _w1�'. "r, 3 ' CD ' o M <br /> CD CLm c 10 y o s F. <br /> Z : N �,� _9 <br /> 7. o <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my [j c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m M c <br /> nom : : x <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizem (D m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Ltzz;z <br /> l7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burne relying on this information I am 'm <br /> providing in this application. I agree to per my officials charged with admt ri�ti cqunty ordinances or other m E <br /> authorized person to have access to the a described n) reason u of inspection. m <br /> m : <br /> m : <br /> SIGN HERE <br /> n to �i7 o <br /> (signal of o n r building contract I' oy ate) 6 ,� <br /> ZONING ADMINISTRATOR C�V/ C f^yly . . . : <br /> %dkjUjyTyIV vi Fn.en fn yr cn <br /> ZONING & N m N N (T m <br /> 666666 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,�j 0 0 0 0 0 0 0 <br />