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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o" �b o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N <br /> TELEPHONE OWNER dpTcLO1 £14DC/ I `I r <br /> \� <br /> w <br /> O <br /> MAILING ADDRESS �qp�y /3�L/,��/�� ���_ A/EiN /'�Gl�/✓!y/✓0 b✓/ S4 <br /> rCD <br /> PROPERTY ADDRESS � 1 <br /> ir'r�,QcE i 5;,C'/W c %4- S Fc. 3 a Y-g'v -t, X /7 <br /> LEGAL DESCRIPTION(see tax receipt) rc,�y � t�«. =,� pato z,` T �� � C* CDC <br /> DWELLING/BUILDING I GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (;, CO ° <br /> TYPE OF PERMIT(S): �Y a <br /> ILLING/ RADING ❑ CTPING UNI ❑ SUBDIVISION ❑ <br /> o�UQ <br /> 7711-2r-. d0 <br /> STRUCTURE/ADDITION USE: /// O'y)E frArl�lC'6z r3r n2.�cy�'v� D4c=' <-y /i-; t ° W <br /> 0 <br /> X SV (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) C . <br /> DcH L r'•� E5 <br /> BUILDING CONTRACTOR: I f� Sal/�/ttp�, t /i✓ m <br /> ��rF.rE �A,�/KHv�t�► zr� s'�� 3335' � -� <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 m rU <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In m S <br /> NORTH(N). to <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES (B)BUILDING(S)TO In <l <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. n <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO (Y�, <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CTOR, ETC.,THE PLANS � --112. <br /> MUST BE SIGNED AND DATED BY THE OWNER. TED W o 0 <br /> 5I� ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER IMCO ff fi1 i ° <br /> NEEDED. <br /> �. 4Y L <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: BORNE <br /> TT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT COUNTY <br /> ISSUANCE. ZONING <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. <br /> 6. m 3 nm Ow �''_" <br /> -o mcy0 !' o � 3 <br /> N1-D <br /> �. m <br /> 1 declare that this application(including any accompanying schedule) has been examined by me and to the best of my 1I��� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of `ti <br /> na icin .'G <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize S)-):: m o : v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Oa: <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 : d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T o <br /> CD m <br /> SIGN HERE <br /> (si of owner or buildi g contractor) T '(date) <br /> ZONING ADMINISTRATOR <br /> hid Slug , s�o��Co <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />