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Burnett County 741RCo. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator G) z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> — r <br /> N <br /> N <br /> / l C <br /> OWNER {+R�bIYC JJ el N- /r.4(���� (ti�� Ne (e j" TELEPHONE6/.47rC <br /> cu <br /> HOME ADDRESS A117 5 tA J& AlA) 9-4-�/5C v 9 <br /> EMERGENCY/FIRE NUMBERA,2f&A/L2,Z/lip ROAD NAM5�( LA&e Q1Q T <br /> LEGAL DESCRIPTION(see tax receipt) ann- CD <br /> DWELLING/BUILDING I� GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y <br /> c <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: 11VAfe la rd/ra! 3lQY�d N <br /> o (� <br /> (Home/Cabin; Commercial Business; Bedroom; D ck; etc.) �/�� w � J✓ <br /> BUILDING CONTRACTOR: t6m, 1181 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE RR� � � m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. I_ NN`` <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) lb O c <br /> T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 60 V0 m ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !° <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 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 I 01 <br /> BUILDINGS, ROADS,LAKE, LOT LINES. W <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. t 0 1 <br /> � o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENCr S <br /> NEEDED. <br /> P <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o yJ <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �C> <br /> ISSUANCE. N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -(Z' 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY \ <br /> PERMITTED. V a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRWATE <br /> SETBACK AREA. i <br /> 5. ©NI( OAj� V IN*M J,.b > o J <br /> (1 (� M M- 0 r 0 O m <br /> 6. gm <br /> �.� am �ce _ .0 <br /> I mcy C � !" � s3 <br /> M `J7. O : A <br /> — m: m <br /> I declare that this application (including any accompanying schedule) has been amined y the be of my i7 Cr p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am ��/�?iJ� for the dnd ac racy of o c <br /> all information contained in this application(including any accompanying schedule)and' iref�d,�eclare that cognize o m A <br /> that this information I am providing will be relied upon by the County of Burnett Wisco dlst w ether to is. <br /> D <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rJ't� �fS�iFi�6rmation la m <br /> providing in this application. I agree to permit county officials charged with administering cou' y ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> CD : <br /> SIGN HERE <br /> (signsur of owner or building tor) (date) <br /> ZONING ADMINISTRATOR • • • . . to <br /> N NNNNNUt <br /> (T (11 O (P (T O O <br /> OWNSHIP PERMITS MAY BE REQUIRED c c c o o c o <br /> 0000000 <br />