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Burnett County 7410 Co.'Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> N <br /> c <br /> OWNER e'� -� �.lL~..(A.�.. M-es�� TELEPHONE ( 7.- }-�0 <br /> n J�HOME ADDRESS 48�- o� �, �� plvl,e..s mo '5501 <br /> `L m <br /> EMERGENCY/FIRE NUMBER (00410 ROAD NAME �� I <br /> /I ____ d 1 <br /> LEGAL DESCRIPTION(see tax receipt) �1 ( CS Y)-, v '4 -7 �j0�t , (p j�7 a- qO Ae < � <br /> n <br /> 013 o) a <br /> o_ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING 50� GARAGE/ACCESSORY STRUCTURE---4ADDITION c <br /> c d1 , <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ur Jaj <br /> � r d <br /> STRUCTURE/ADDITION USE: 30 X iu C�z <br /> ome/Ca ' ; Commercial Business; Bedroom;Deck;etc.) < <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> ?r p _Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). U) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m C"� v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. J ° <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, 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 I <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. _a <br /> J <br /> c� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY T J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. r <br /> nga 3 L g m <br /> 6. �+ L©41st �Tu� 1 X43 `rt = z <br /> U A S QY' ,4��/C uc.+�`S ��l P/l!�/t/ tel—L�//✓iL�n�S�o 9 N o ^ 7,p 3 <br /> Z : _� <br /> 7. o E .0 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m m <br /> that this information I 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 County of Bsu EZc,: <br /> mtion I am 'm <br /> providing in this a lication. I agree permit county officials charged with dtii�dl t or other � ; mauthorized perso t have access to above described premises at any res 0 i spection. T <br /> m : <br /> Lj <br /> m E <br /> SIGN HERE � f� <br /> (signat a own or build tractor) ;',� JU" -T "' ate) <br /> i <br /> ZONING ADMINISTRATOR . to <br /> N N 0i <br /> P P <br /> � u, ooo <br /> OWNSHZONING IP PERMIT MAY BE REQUIRED 00 <br /> 0 0 <br />