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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v c) G Z <br /> APPLICATION FOR LAND USE PERMITS 3. 0 �, <br /> - r <br /> i, 0 <br /> N <br /> OWNER Z,� 4. %Sc� TELEPHONE//5 -&6 S-z6, C <br /> HOME ADDRESS <br /> 6060 .air£y �� /�/e��%�P 4J,' �Y�9 3 <br /> EMERGENCY/FIRE NUMBER 6060 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> w a �s�J air-ala -i� <br /> 1G I m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LTJ ADDITION ❑ PRIVY ❑ + rn 0 <br /> TYPE OF PERMIT(S): I a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °' <br /> STRUCTURE/ADDITION USE: 3TUDP/}9C /YjdTd�Q/7�CI✓I P -�/�Li1Cf Eft `� nn , <br /> (Home/Ca 'n; Commercial Business; Bedroom; Deck; etc.) rn Y ) <br /> BUILDING CONTRACTOR: C�/�� �P c(Cl eA,.- <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O C -� <br /> N d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. P <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v 0 WNOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q °, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: oo(>` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N <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 lT' <br /> SETBACK AREA. <br /> 5. 0 ,�oQ,a�. h a�,� d�� <br /> ..r zv0; o �ov <br /> 6. cco � 3nm � ? � <br /> CD C7. u'" y o 53 <br /> o : <br /> fn : M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m m <br /> PP (� 9 Y ) Y Y �c fJ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to thea ove described premises at any reasonable time for the purpose of inspection. <br /> f m <br /> 6 <br /> E <br /> SIGN HERE �dUO '69 : <br /> (signature owner or building c V or) (date) <br /> ZONING ADMINISTRATOR <br /> " to cn cn er Fn fn <br /> O PP <br /> VI Uf U1 (11 O O <br /> dWNSHIP PERMITS MAY B REQUIRED 7f 0 0 0 0 0 0 0 <br /> SG67 �NS <br />