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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> OWNER I"1r MYJ gV-D1 1 WlGILMC�n TELEPHONE 7b3-C/)7�y d l (� n <br /> O <br /> HOME ADDRESS MA6JaSbo� N,(.�), f�amseu (1nl'1 5�3�3 O <br /> EMERGENCY/FIRE NUMBER � ROAD NAME �D ~ <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) L� UOI JJ. Cln n -3g A'5 C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRtUCTURE ❑ ADDITION ❑ PRIVY ❑ 1 C <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT (❑ <br /> l SUBDIVISION <br /> STRUCTURE/ADDITION USE: �❑�y �p /f, X /I o <br /> p �' (Home/Cabin; Commercial Business; B droom; Deck;etc.) <br /> BUILDING CONTRACTOR: �ty ,n wo l-�O rd <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE ORCD <br /> (� T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C tis<<, ,_. rG� k C O <br /> S y <br /> IRECTIONS FOR PLOT PLAN DRAWING: AERIAL OR TOP VIEW) I-c ( <br /> AO <br /> T T. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). go <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. tj o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS, 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 ) o <br /> MUST BE SIGNED AND DATED BY THE OWNER. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a o <br /> NEEDED. <br /> r. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: AJ I <br /> d <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. J <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 AI EA. <br /> 5. <br /> —IV� 1� Alc� Ch �Yz,�/Nay (.�iin .�('��� G� �r�l)na,� �a�l� �c�A- / PM <br /> I J yy m � 0 � 0> COD a0 <br /> m � 3 'am01 - `D <br /> cn <br /> I declare that this apolication (including any accompanying schedule) has been examiiied by me and to the best of my <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 I recognize mCD� <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> : <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 � <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described remises at any reasonable time for the purpose of inspection. N <br /> '' 11 CD <br /> m <br /> SIGN HERE ''WAC <br /> (sign re owner or ui ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> b <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />