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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS . �� <br /> r <br /> CD <br /> OWNER �'f/CA'1 �4A16 (i L/ li[i� A�dVLE` PHONE ZZ-7 �(O 3- -/ Zj 7 n <br /> v t„ <br /> �w O <br /> MAILING ADDRESS <br /> � r � <br /> 0 <br /> PROPERTYADDRESS <br /> �/� � <br /> LEGAL DESCRIPTION(see tax receipt) �`� /o ��—eSAV17z 406, 3'5-7, 99 Z I "tCn <br /> j <br /> 77Q <br /> DWELLING/BUILDING 5Z GARAGE/ACCE ORY STRUCTURE ❑ ADDITION ❑ rr,,11 0 <br /> TYPE OF PERMIT(S): W c� <br /> FILLING/G IN�� ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: G/A/ a X a 1-3 X a6 Covey-ed h! ` 0 \ <br /> ,// '',,// (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: N�-41'o 9 �.AYI �O✓S rr-- \/ <br /> CD 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. -n <br /> O <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p o <br /> n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n lu <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i <br /> NORTH(N). C3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO ca m <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. w o <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. 1 Q <br /> 1 N t, ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, v <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, C T C7OR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. llll <br /> 1 v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT ICATIO a o <br /> NEEDED. 2 <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 9llns o �U <br /> CONDITIONS OF PERMIT: <br /> I <br /> SSVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEM)?0jV c0U/v'ry p <br /> `� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY L: <br /> PERMITTED. bi <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. <br /> 6. M <br /> 3 'am xa ^ 0 <br /> D N N p <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my //', - r^ A <br /> W: �� <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n : v+ C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 appjj0btionj.,1 agree to permit county officials charged with administering county ordinances or other d <br /> authorized personWhave jffess to the above described premises at any reasonable time for the purpose of inspection. " o <br /> CD m <br /> SIGN HERE <br /> (slgnatur o 0 or i ntractor) ate <br /> N <br /> ZONING ADMINISTRATOR / �3 O <br /> . . fn d, <br /> fAr) N aEA <br /> 0 N <br /> N (T O O <br /> Q (TON Vt O O <br /> /(OWNSHIP PERMITS MAY BE REQUIRED _�_ p <br />