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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r- <br /> 0 <br /> N <br /> OWNERhQeh- 1110'rX � )�L TELEPHONE 67I 7S-y- C1c3� m �J O <br /> HOME ADDRESS �9ll0 1 II?7 S /1 , � Lallas .-j v 7S�6y v j j�/� <br /> AV � tS r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) T4174 07 ''SC1577 60V YJAal' -Se 1s 7110 R IV Loi, <br /> 0 p <br /> v. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ a) 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNI SUBDIVISION El a <br /> 5. <br /> STRUCTURE/ADDITION USE: 3 „�( j LSZLI t <br /> (Home/Cabin; Commercial Busine' ; Bedroom; Deck; etc.) y <br /> BUILDING CONTRACTOR: kP.YI L& .Dsj/ CD <br /> J <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O G <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `D <br /> n a <br /> 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 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) �. 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF -42.-.12, Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. O <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 ov <br /> MUST BE SIGNED AND DATED BY THE OWNER. 4 0 1 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 <br /> NEEDED. pa <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2C Z <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 D OF P IT Va <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALOIIt�$J OORRE`LINE. 6 / %/ Q113. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPE / � U <br /> 4. NO STRUCTTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE RAI�n XV11� t1 <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential ��Vlljj T <br /> m �< iuiu Moem <br /> garage/storage only. Not to be used for human <br /> 6. habitation. <br /> N ` V a y y g <br /> A : <br /> Amo : ��'c — <br /> 7. Z : y 0� q <br /> o : <br /> l_Cn 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 1 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 ---4m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ,Z1,6 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 OQ m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r <br /> CD <br /> CD <br /> SIGN HERE Z <br /> ure of owner or b ilding contractor) <br /> ZONING ADMINISTRATOR _ IQ <br /> N N Nut <br /> V7 Ut p O CAPP O O <br /> y <br /> �1 �J2 aur)AWL - -UL� TOWNSHIP PERMITS MAY BE REQUIRED Q�/ I 0 0 0 0 0 0 <br /> 1v o 00 000 <br /> '7- �sUd- v <br />