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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator m a o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> R N w <br /> OWNER 62en-q!e /✓ro%-4.Lt TELEPHONE r�� �/T�7-p�Y3Z <br /> HOME ADDRESS 3,Zp 6A), 6& G �- Ll VPr Cjc /iDc�e 4i(sr / G Al JTj7 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER a0�0 5/�j� ROAD NAME p��I <br /> LEGAL DESCRIPTION(see tax receipt) D'/J <br /> DWELLING/BUILDING ❑ SWACCESSORY STRUCTURE ADDITION ❑ PRIVY El <br /> m <br /> �t <br /> TYPE OF PERMIT(S): Cr ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> /� / <br /> STRUCTURE/ADDITION USE: '/-e t-k S [" <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> m <br /> BUILDING CONTRACTOR: C) t.Ai Neo- V r <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 � <br /> 2! z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 1 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 ) , <br /> BUILDINGS,ROADS,LAKE, LOT LINES. T/ R' S�I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. U <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,� o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT U) , <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 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. LL ( f <br /> s. se7'�¢c� tc.o +ke- 4 do0) 64z /'u Irl , ��`fes-- 60 M -0 d d oL o <br /> 6. y <br /> 7. ; " �,< : <br /> =y€ i i 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 I am responsible for the detail and accuracy of a g <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 o <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. <br /> m : <br /> m : <br /> SIGN HERE I <br /> (signature of owner or ul ng c «s7 ( te) <br /> ZONING ADMINISTRATOR 4D <br /> HHHHw�� <br /> N N VINN (rfl1 <br /> ��r3a_ a -0�C00 <br /> TOWNSH P PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />