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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r- <br /> 7 o <br /> N <br /> C <br /> ��ff j/'�� �� >) J /� fD <br /> OWNER �l1�//VC/ /VGA e//LI t`l�sSD TELEPHONE . <br /> IY� v <br /> HOME ADDRESS ;rA •S/• /✓ LLGL�r--/rIA� �tJQ3'O v O <br /> a r N <br /> 0 <br /> EMERGENCY/FIRE NUMBER �S�7/ ROAD NAME &90. <br /> 1'0-r A. <br /> LEGAL DESCRIPTION(see tax receipt) T "A A �V /! ,��,eSVw �• CD <br /> T '�Y�/-j /b7 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION�I PRIVY ❑ (/> <br /> TYPE OF PERMIT(S): T <br /> FILLING/GRADING ElCAMPING UNI ❑ SUBDIVISION ❑ a <br /> / N <br /> STRUCTURE/ADDITION USE: �J�}Gi .22= z dL/ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn (� <br /> BUILDING CONTRACTOR:�/V�/L—/ L1/aC5 iit1 � <br /> 1'71 --a.59 - 3 <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a <br /> T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATECD <br /> NORTH(N). CO) 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m I r <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V ' 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 U <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. 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 0. 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. O <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN = ° QJ <br /> NEEDED. (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: p, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (51 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �(J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 10 <br /> J 5. , , : . <br /> doMf <br /> 6. nl'� � � b be 0/4, Sr,kk- /( L. ne- M. a m <br /> rI „ o < 3 ao oCD <br /> n � <br /> 5-6,(jc�ur�(eve, G�eCk� e--4 ) Veir �/ '� I I n&/I ' ece' a m y a " 3 <br /> m <br /> 7. <br /> m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) 2 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of (j1 a <br /> all information contained in this application(including an accompanyingschedule and I further declare that I reco <br /> -cognize <br /> PP ( 9 Y ) 9 ° m p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- V j L7 <br /> sue a permit. I further accept all liability which may be a result of the i Tis i9formation I am m <br /> providing in this application. I agree to permit county officials cha <br /> Ell La rtlances or othe o <br /> CD <br /> authorized person to have access to the above described premises f 4sia1of inspection. T E E <br /> CD <br /> i <br /> CD <br /> l v, <br /> SIGN HERE AP11 <br /> (signature of owner or building contractor) date) <br /> ZONING ADMINISTRATOR )IMI BURNETT COUNTY <br /> � <br /> ZONING /9553-1)nl <br /> TOWNSHIP PERMITS MAY BE REQUIRED /&YqE�"( <br />