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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ; 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ 66/2) 359- 3524 lw) <br /> OWNER10pj N1 ¢ A-2-eo rm Y AMLSTlLAND TELEPHON&J 2) -,666 -3267 CH) v -� <br /> M Pi- 6 4 D L/N ToN A✓E. o• f G mo 1 6 t,Olo MAi. 423 � o <br /> HOME ADDRESS C 1-jq X sJ 3 /4'16 5-r q PL ES I-x x& ?DAC 8d/Z w3', 9 <br /> CD <br /> EMERGENCY/FIRE NUMBER 31416 ROAD NAMF5'rRQL95 L,OK & R U. 1 <br /> Carllir LUQ 6eVTION / 70W"5Nip C4/ tJJ a <br /> LEGAL DESCRIPTION (see tax receipt)AJO�7*Nj �/6 AJ4! r 15' yvL 5T- ToWNSh//P Cly a'W155 Cn <br /> e <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIITT ❑ SSUBDIVISION ❑ H <br /> STRUCTURE/ADDITION USE: f-faM /��/•� �N 0 <br /> '(Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: y/0 A./ LoSYR/oN go <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <br /> NORTH(N). w 3 <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 rr II'' 'rt Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. W V <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS,ROADS, LAKE, LOT LINES. Z 0-- <br /> 5. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 1 �, <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ) <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN rn <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: I <br /> P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT S� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V <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 RJ <br /> SETBACK AREA.5. <br /> Jj <br /> ef CDM -0 W 0 0 0 9 <br /> CD CL m <br /> 6. 2D CL M v Ctny <br /> CD <br /> Z m <br /> 7. o -1, <br /> =cn : <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m tj p <br /> PP ( 9 Y ) Y Y C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize I m m i <br /> p: : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �? i O <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 Q <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other to(D <br /> authorized person to have access to the aboy"escribel premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> M <br /> SIGN HERE <br /> (signature of owner or building nV tor) date) rr�_ <br /> V` <br /> ZONING ADMINISTRATOR / ®® <br /> �6% A � <br /> N N (J I N N U 1 N <br /> N fn O N p O O <br /> TOWNSHIP PE ITS MAY BE REQUIRED o o o a <br />