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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -D cr Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N w <br /> N <br /> OWNER dK ,4- 01V► D PHONE <br /> o <br /> m <br /> HOME ADDRESS,.j 45-9? 6jois 600 � (��✓ ) <br /> EMERGENCY/FIRE NUMBER ��/t✓g ROAD NAME <br /> .93 <br /> LEGAL DESCRIPTION(see tax receipt) ch <br /> y� N <br /> DWELLING/BUILDING ISI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ m 0 <br /> TYPE OF PERMIT(S): cCr <br /> FILLING/GRADING' C9,MP G UNIT ❑ SUBD ISI ON a <br /> b r <br /> STRUCTURE/ADDITION USE: AAgaiMf <br /> (H /Cabin; Com lercial Business; Bedroom; Deck; t <br /> BUILDING CONTRACTOR: -,C. 4 YJCZjOY <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE im <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 QJ <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 <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 00 <br /> MUST BE SIGNED AND DATED BY THE OWNER. -.4 _ <br /> to S0S <br /> O 9 d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa 0 <br /> NEEDED. C 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P ;" <br /> , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> / /r 1 yip a <br /> QUI e /�yJ7e / ��?Z©U�'G�QS �C (L�G(C e zvcrrpODaorn <br /> -. mCLhm m <br /> 6. (D C=W, W 0 = <br /> 7. lie �d Goy? f- 7�(6�� lS k477 r'�rr� Q , o : COD <br /> _v, s m <br /> 1 declare that this application ncluding any accompan ing schedule) has been examined by me and to the best of my �j p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other cf°o <br /> authorized person to have a cess t the above described premises at any reasonable time for the purpose of inspection. T <br /> M <br /> `� <br /> SIGN HE d' ' <br /> (slgnature o owr bu- g t c .f (data) <br /> ZONING ADMINISTRATOR pp <br /> vi to t»t»w cn <br /> N N N N N V 1 <br /> Ut ut O Vl V7 O <br /> TOW SHIP PERMITS MAY BE REQUIRED 0 0000 0 <br />