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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> VT O ^� <br /> N W <br /> /� C <br /> OWNER iNeY� �(si�`��-- TELEPHONE '"�� '- ��� -�jS.J(, n `� <br /> MAILING ADDRESS 00S F151 R ,,c L.4&-c 341Okk 44 /is d:f> � o f <br /> D <br /> PROPERTY ADDRESS J Lp 3W <br /> 6 <br /> LEGAL DESCRIPTION(see tax receipt) Sym, I,tec ��Nt,�yr 6 �1 �t� ul <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION N 0' <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: C1' ��lr0 1, O e k 5�t Ir'S C Oki l l ri o <br /> (� (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) co <br /> BUILDING CONTRACTOR: c+�YYl it C r4/5 �G5/✓S CY��j(�►� -71 77 '- <br /> d <br /> m FZ-< <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p o <br /> m <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF (T z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO a <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 1 R <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. YJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CTOR, ETC., THE PLANS 0 d <br /> MUST BE SIGNED AND DATED BY THE OWNER. I o i <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V FICATI DNfrf �y <br /> NEEDED. �% L/ � I <br /> SUN_' �� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 9 Z <br /> Alai o <br /> CONDITIONS OF PERMIT: C(J <br /> F3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFERRnN►ytiE,e CpUNrY O <br /> ISSUANCE. �lJ NG ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. / <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. <br /> 5. <br /> 6. 8 3 n m v a m <br /> v mcy � o � 3 <br /> 7. Z info : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ( - - r^ A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofU� d n <w c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 2 o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 CJ L7 <br /> m : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m o <br /> J� -{ ` m <br /> SIGN HERE 05 ^�"`^s��- 6/9/0`T d+ M <br /> (signat�f owner or building contractor) // (date) <br /> ZONING ADMINISTRATOR <br /> war, <br /> fmL cL� v TOWNSHIP PERMITS MAY BE REQUIRED <br /> c : a3 u4 <br />