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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 <br /> r <br /> N p <br /> N r`� <br /> C V <br /> OWNER <br /> II_ 5►1 Gtr I � ✓Yt 1 1 TELEPHONE c- <br /> o � <br /> MAILING ADDRESS / 5 7 1d ADDRESS - I ria l ' M ' 2- <br /> Z D <br /> PROPERTY ADDRESS 622-6) N �GrSS ���� � � ,We-1b 4ej-- Wr— 0 � <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 7T # 018 -331 Li-o Z 700 Q, 0 <br /> DWELLING/BUILDING1:1 .n. <br /> TYPE OFPERMIT(S): GARAGE/ACCESSORY STRUCTURE ADDITION � o <br /> c � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ mUt11vCc;4bX'I a �� <br /> STRUCTURE/ADDITION USE: {2>eA <br /> o' <br /> (Home/Cabin, Commercial Business; Bedroom; Deck,etc.) c <br /> BUILDING CONTRACTOR: D I/J Y1(.("' Sero <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) <br /> O m <br /> -n C- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n 9 A <br /> NORTH(N). <br /> M <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. I Z <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 /> CIIQ <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N !i- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> �. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o� <br /> NEEDED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o <br /> f I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 /> See, <br /> Z,0 -I0 be ins-k0lek b_e fcu e.¢r) la4e cold BIdS, side &iv:?S) <br /> 6. N VIII ` ♦ Q CD� C� r 0 Im <br /> • �.7 vGZ 1'I&A CL C4St. ✓10. a � ' _S�j� C2hUd�n B a MO O n m <br /> 7. o eKcaua �,h- o-L �I( tvi`I-L� 3s ' �y y o 3 <br /> z ymo ' ' off <br /> T� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> cy <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d�, v, S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' <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 oO <br /> providing in this application. I agree to permit county officials charged wit I r " m <br /> authorized person to have acces to the abov escribed mises at an r 1 �� m1l�lces or other , <br /> Y e paf',irlspection, m '. � <br /> � �— r� _ m � <br /> -no <br /> V t � . <br /> SIGN HERE (D <br /> (signs f owner or bu din contractor) APR (date) <br /> ZONING ADMINISTRATORIJUMINIt <br /> o�UrLP�L p;cKQd ccs ^ I �o� o <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> N <br /> V\ <br />