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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 /> m \ <br /> C <br /> �y 6 <br /> OWNER 177i to O�,y/ C R / 'J L TELEPHONE o <br /> / i - <br /> HOME ADDRESS 91, H No A) AIE S O i C 6 T Ti4G i l�n <br /> /LOVE' AV <br /> / o �CD <br /> EMERGENCY/FIRE NUMBER tp y ROAD NAME I Q f BUJ p <br /> /yiE.2(a �I a('3 /a9s sdG T34/ �� <br /> LEGAL DESCRIPTION(see tax receipt) 4GREs 1•aoo - a- 3 9-/ —..2(-O oS/c� ( "n 1 <br /> PCL moo✓ cp <br /> c <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY El1 Cl) ° <br /> 1 ' <br /> 17 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 ^1 <br /> n H <br /> STRUCTURE/ADDITION USE: L l V YN off VV ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: /CO M c /� ��} ✓� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 (� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> O 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 m 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 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. <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. <br /> S. 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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. <br /> 5. �Ir /Tt� X 'a 0 <br /> 6. CD m K <br /> 7. o m COD <br /> ZM 0 1 <br /> ly : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q n E E <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m m : M <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information lam <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. T <br /> Q : <br /> m : <br /> SIGN HERES��Ga©O O <br /> (signature of n ar building con" (date) <br /> ZONING ADMINISTRATOR Z� <br /> N N °1 NN(T (T <br /> (T (T o (T(TOO <br /> TO NSHIP PERMITS MAY BE REQUIRED ° 0 0 0 0 0 0 <br /> 0000000 <br />