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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 /> rn O <br /> m <br /> c <br /> fD <br /> , a <br /> OWNER QrIQ.,) an161 Ti 1 W k A (e/- TELEPHONE o <br /> MAILINGADDRESS Qally RIdG'P '0r-1 'p IAMOd L#-cj . M.AJ, SM2S- CD <br /> r <br /> _ <br /> 0 <br /> PROPERTYADDRESS 86Sy (� �uSS to k* kd b4'U 444&-7 In/S <br /> *may R� <br /> LEGAL DESCRIPTION(see tax receipt) ( _ y y/Y - o.S- 900 sec- Iq Tw P 4o g 17 <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LYJ p cn 0 <br /> TYPE OF PERMIT(S): �\ v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> l <br /> STRUCTURE/ADDITION USE: IIJ p Q t CPEO �l — n1tW 1 l' a 1`b 7S�S� lLd IT/awl ° <br /> _ <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) ori <br /> BUILDING CONTRACTOR: J2_6 C? (,0)S fvtA C-+/0 L <br /> 42 <br /> v ( I_ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � d <br /> � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> -A 6 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mm A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N <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 <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. !� <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <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. y� d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Q) S <br /> NEEDED. 2 \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: A (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V\� <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 IRED T <br /> SETBACK AREA. A ^ f <br /> 5. <br /> —C [5 Std. ,� m Wm 0a m <br /> 6. [V 0�� 3 =a m Ix <br /> I n/)� Z y `�° 7 <br /> 7. <br /> M <br /> I declare that this applicatio Including any accompanying schedule) has been examined by me and to the best of my f 1 ) G) p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> n� : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 0 : my <br /> that this information I am providing will be relied upon by the County*Pu ett Wisconsin in determining whether to is- <br /> sue apermit. 1 further accept all liability which may be a result of hk�ME, <br /> tt relying on this information I am m <br /> providing in this application. I agree to permit county officials acei ordinances or other o <br /> : : 0 <br /> authorized person to have access to the above described premise at anu ose of inspection. o <br /> _ 4 m m' : <br /> SIGN HERE <br /> of owner or buildin co ractort� n <br /> (signature 9 t f 2Q� (date) 1- <br /> U r o <br /> ZONING ADMINISTRATOR G . <br /> DN/NG <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />