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=f' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y O <br /> 41.2- 9oG- j03S- <br /> OWNER II \ It i <br /> S S4 krnS OVt_ TELEPHONE �Cdba. ?S9_ 7GSp <br /> m _ <br /> CD <br /> HOME ADDRESS <br /> O�n Qoe-1 mf� <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME L <br /> LEGAL DESCRIPTION(see tax receipt) LoS��i Ri IaZanAv2 <br /> LION. <br /> �{ IyW, <br /> C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ (q 0 <br /> TYPE OF PERMIT(S): <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> N <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ur <br /> m <br /> BUILDING CONTRACTOR: -rice CortST'RU(=4l I tv <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 _ <br /> rM <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o I n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In B <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. 4C� pZ <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. (� G <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N f�1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS � 0 Y/ <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q S <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: .0 )� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I" n <br /> ISSUANCE. �(J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. (1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (f• rV� <br /> SETBACK AREA. t� <br /> 5. �eCK �P reln&L&-l or Al�rc�J -7t fneef ��tt sp-/�6 -� �i c)r» C)ffw./�7 o o <br /> 6. r�lcO <br /> � we p2LLy� ck-oeLlt� � r�/ a ` 0 <br /> VX R 5. F. <br /> 7. <br /> y : ."0 <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 o.e . C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m t3 <br /> J <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I amm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 'J'-``i m E E <br /> authorized person to have access t e above de a remises at any reasonable time for the purpose of inspection. 0: <br /> q m <br /> SIGN HERE <br /> (sigu of owner o w ng contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fA 4A14N40un <br /> N In NN ITN <br /> (T (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED [�'JD��a 0 0 0 0 0 0 0 <br /> 0000000 <br /> �0�t�3 <br />