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Burnett County 7410 Co. Rd.K, No. 102, Siren,W154872 Office of Zoning Administrator vc, Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> VT 0r <br /> CSo7)Gt:3- 711/4- <br /> (N) <br /> QWNER LyN/✓ Sfif:LF 'rpPEN TELEPHONE ) 'ft4 Z93$CC) <br /> MAILINGADDRESS 71. 07 H�G/ff:flNa �VE( i N�+FfrTl JG�!/� /r�N SOS <br /> PROPERTYADDRA <br /> ESS /TVP"(1-OT Is LpCAm wi.5T of sw4 #Amm LA}1£ Ro) I <br /> GovE/Zn ?hfxT [.07' 2 Su[3 CoT/8 Sf�T1aA/ 7t D <br /> LEGAL DESCRIPTION(see tax receipt) TyON /QlSiv� TACKSoN '-*W9S#1P(t CD <br /> DWELLING/BUILDING IAl II��77I <br /> GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ _4?00) v! o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> X �d <br /> STRUCTURE/ADDITIONUSE: #,9ME �R o <br /> -�- (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) rn <br /> / I <br /> BUILDING CONTRACTOR: rcE C4/✓�]R. '- �I <br /> m <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. <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m C <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m o A <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m per' 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �` 1 <br /> so <br /> BUILDINGS,ROADS, LAKE,LOT LINES. 1� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRItL6�OR, ETC.,THE PLANS O � I <br /> MUST BE SIGNED AND DATED BY THE OWNER. ` )�' � T _ 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIcA ION MA o O 3 <br /> NEEDED. LLL111 c'� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. yrAz o �` <br /> CCONDITIONS OF PERMIT: CuUJ <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Zot COUN1 <br /> `^1 <br /> ISSUANCE. ZONA Y Q (Z <br /> N� <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 Q) (d <br /> SETBACK AREA. <br /> m an d rDi a a 0 <br /> 6 <br /> 3 nm sam <br /> 7. N C <br /> Z <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n : d, <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize © m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- fD <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 descri d premises at any reasonable time for the purpose of inspection. T D U)0 <br /> o : <br /> (D m <br /> SIGN HERE <br /> : <br /> ( ature of owner ohuilding con a tor) a <br /> (date) E <br /> � �jC�'/ Q <br /> ZONING ADMINISTRATOR Vllrl ( I1/Gfi�'/1 (� <br /> fA EA fA fA t N <br /> N V tN N O O <br /> N (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O (TO <br />