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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> r <br /> 5 o <br /> c rn r R <br /> owNER / n + r a f`t Pr�na r0A0(5Pv TELEPHONE -�l5 - (135- 9Y'Y7 0 <br /> MAILINGADDRESS A 1/77 O <br /> r <br /> o <br /> PROPERTY ADDRESS 3;Z91 k )3.- 0 O it �` �• _ <br /> 1 <br /> receipt)LEGAL DESCRIPTION(see tax ret) / m <br /> _ A!c y� ,ryt✓ /y 5 3 a T3 9 Ar 2l y W <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ / W <br /> 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: Rome e o <br /> r <br /> (Home/Cabin; Commercial/Business; Bedroom; Deck; etc.) U) O <br /> 2. <br /> BUILDING CONTRACTOR J C/1 f O C k C bh$ �y I t Ct/6rt Zhf• ��5—S Sg��[y7 v' '1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N K <br /> N JJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <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 _QJ <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. 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 O <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 10 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 (1 <br /> O W <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT _` I C <br /> ISSUANCE. `�7J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> mmmnoaov <br /> M <br /> 6. m x 3 a m y a m A <br /> O N C y N 0 = 3 <br /> 7. <br /> = cn m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m -4 : O <br /> Pp ( 9 Y ) Y Y E G) � ; C <br /> J _ ; <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 1 further declare that 1 recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is v <br /> 61 : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m : o <br /> providing in this application. I agree to permit county officials charged with admi 's r CDr <br /> authorized person to have access to the above d cribed premises at any reasona¢ i t m <br /> a : <br /> D <br /> m n . <br /> SIGN HERE <br /> (s' at a of r or building contractor) JUN (date) <br /> ZONING ADMINISTRATOR r /C�WJ[ <br /> BURNETT COUNTY V O N Cin W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ATOF <br /> nUAA NG <br /> THIS.RMmSF�A� Ie`I-I�rEmzI �QDE�59SWI1s77/AcT[D(� lo._ /—�� <br />