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oUtme <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y o <br /> N <br /> OWNER AI Ir�IP,Thi I lA,I/j,,, / ✓ l �'�• TELEPHONE 7l� -L��—�� 4o <br /> yn/ YY 4 /,itI O <br /> 2 4� W�l Y <br /> HOME ADDRESS ( 'P �'(�! A�y rK 6'4 T-3 CD 00 <br /> EMERGENCY/FIRE NUMBER ROAD ROAD NAME (Nj115��✓l��( l9 �^ <br /> LEGAL DESCRIPTION(see tax receipt) /wW.LV®/3 41P-/4S &t' 4- 5 ece I Ta)611 "A ,� y <br /> A +{J N CD <br /> o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE)z ADDITION X PRIVY Ely o <br /> TYPE OF PERMIT(S): � <br /> or <br /> FILLING/GRA ING El CAMPING UNIT- SUBDIVISION ❑ n. <br /> C) 5. <br /> STRUCTURE/ADDITION USE: LI e� Ln. <br /> L#Home/Cabin; Commercial Business; Bedroom; Deck; etc. <br /> BUILDING CONTRACTOR:_ �G/'YI '/�Q/wkt <br /> .� <br /> 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 /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> o- <br /> 1.1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> O <br /> 2. <br /> SHOW T NE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C A -J(:. <br /> NORTH 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <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 0 n <br /> MUST BE SIGNED AND DATED BY THE OWNER. c 7. <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �O <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V <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 /> 5. BACK AREA. <br /> , <br /> 6 TO ` m6y7Cu� y0 <br /> 7. S. z �^ o . m i <br /> o : <br /> =N: m <br /> I declare tht this applicatiorkincluding any qfcompanying schedule) has been examined by me and to the best of my t$c p <br /> knowledge fnd belief it is true, correct and coftlete. I acknowledge that I am responsible for the detail and accuracy of In g : c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is o <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 agre to permit county officials charged with administering county ordinances or other m <br /> authorized perso to have access the abo described premises at any reasonable time for the purpose of inspection.ell T <br /> m : <br /> 1 (D2rtc0_ <br /> SIGN HERE -g :: <br /> ignatur o wn b ' o ractor ff <br /> ^(date) ? <br /> ZONING ADMINISTRATOR / <br /> Fn v+<n fnutn� <br /> N N Ut N N(l (n <br /> (n (Ji O fly(T OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 0 0 0 0 0 <br />