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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> -7 7 SS'- <br /> Kk <br /> 2811 = r- <br /> OWNER � 5A( orv) 6 C-t-A j_ TELEPHONE <br /> rv <br /> HOMEADDRESS 2t61V tV � 5'ft�Z� v 0 <br /> jj m <br /> EMERGENCY/FIRE NUMBER 2, 3S 1 -L ROAD NAME <br /> 211-1 <br /> � -T 38J �17 I� Yr9cKi, HO <br /> LEGAL DESCRIPTION(see tax receiptT 2 -. t'I- -U OZ m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): N ' <br /> c <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> S. <br /> sa <br /> STRUCTURE/ADDITION USE: o <br /> (H me/Cabin; Commercial Business, Bedroom; Deck; etc.) rn <br /> �— m <br /> BUILDING CONTRACTOR: 11cm le <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SH T OF ER. IN MPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (A IAL OR TOP ) O o <br /> T Z <br /> 1. ALL REQUIRED DIME IONS OR DI TA ES TO OWN ORD AWN TO SC 0 m � <br /> 2. SHOW THE LOCATIO D SIZE O L ISTIN UILDINGS B ND L N LDINGSZNB)fALATE m <br /> NORTH(N). n <br /> 3. SHOW DIMENSIONS FEET F OWIN A) BUILDI O ALL LOT LINE ( B ILDINT m 3 <br /> CENTERLINE OF RO D,(C) G )MEAS E RDINARY HIGH )OF <br /> LAKE,STREAM OR VER EASUREMEN O A EAS. o <br /> 4. SHOW THE LOCATIO OF WELL(W),SEP T ST)AND DRAINF D( UADRIK(O <br /> STANCES TO <br /> BUILDINGS,ROADS, L LOT LI S. <br /> 5. INDICATE IF A WALKOUT B PLAN AND SHO EA E GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE TE BY AN ARCHITECT I UILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DA T OWNER. o <br /> ! v � <br /> NOTE: BUILDING/STRUCTURE OCATI S TSEiAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN " <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL COND IS LIST B o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH QU MENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEG TION 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 <br /> SETBACK AREA. <br /> 5. <br /> 6. m 3 n m 0 a <br /> Toc(-fw mc0 " > > 3 <br /> 7. ((k5I("Lf;�at1j <br /> 7 f...� In7ms F/Ay' J(c 'Z : m ° ° <br /> ejak( �f S5 l et/' Y0 1 f a `-'0elyl P fn i ) <br /> II declare this application (including any accompanying schedule) has been examined by me and to the best of my L7 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 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing willpe relied upon by the County of Burnett Wisconsin in determining whether to is- uG, O <br /> sue a permit. I fur' accept all I' il' ,which may be a result of the County of Burnett relying on this information I am m <br /> providing in this a pl cation. I r e to permit county officials charged with administering county ordinances or other m <br /> authorized person o ave cce to a above described premises at any reasonable time for the purpose of inspection. m <br /> / m . <br /> m <br /> SIGNERE <br /> ti <br /> (signat re of owner or building contractor) (date) <br /> d <br /> ZONING ADMINISTRATOR <br /> cn cn f»cn En <br /> N tli N N CT <br /> VO ut N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />