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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> OWNER U � 1 6 Y 1 ��� �'�cel TELEPHONE 1'05 �- Z1J /- 53 / / o �. <br /> P <br /> MAILING ADDRESS 13o? 5 43� <br /> 5S0O Z— r <br /> PROPERTY ADDRESS a 8719 O ui L (. FO--J, S/ r&AJ j � 1 <br /> LEGAL DESCRIPTION(see tax receipt) .< 3 Se 6�I D Iy T J g iv W ` m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ Q U) o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ {Je <br /> STRUCTURE/ADDITION USE: /)lq ,X t t 7 �� <br /> IF (Home/Cabin;O mmercial Business;Bedroom;Deck;etc.) m\ <br /> Qo 1 <br /> ' <br /> BUILDING CONTRACTOR: /1! a"aA ZLw PCX <br /> CD � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 33 e <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> n <br /> tl O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m� � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). to �- <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Zck <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0`�F <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO l <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. )ON 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. O <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSI I E WHEN - 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. JVH n I o cs <br /> CONDITIONS OF PERMIT: e� 7ft ,Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 Aft"I / '� <br /> ISSUANCE. LL►►������ oli <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHn "I rT <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, <br /> �ETTCALLOWED WITHIN THE REQUIRED WATER <br /> 5. �� <br /> SETBACK AREA. 6�1YVC Z�� —L i�'�C✓�" <br /> � V <br /> m w d m a f m <br /> 3a " ami <br /> 6. Z N M O y O <br /> 7. o n r�r1 <br /> 1 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 I am responsible for the detail and accuracy of o 0 : .n <br /> CLte : n : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o :CD my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to ccess to the ab ve described premises at any reasonable time for the purpose of inspection. `D o <br /> ` CID <br /> m m : <br /> SIGN HEREp"�-- .4A le' <br /> CL : <br /> (signal re of r or b do or) (date' <br /> ZONING ADMINISTRATOR �` <br /> �a3g—S mn C 0 0 <br /> TO NSHIP PERMITS MAY BE REQUIRED <br />