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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -VO Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> r^ <br /> OWNER J o Y l IA p 1Z'0(,-t G� I J 11 TELEPHONE(\& � p <br /> HOME ADDRESS vL 7a /Vr-V*bA- rv;E Gocrri4 , M PL51 M Al S5 4V-2 O_v <br /> EMERGENCY/FIRE NUMBER ✓ 9d r � <br /> ROAD NAME ��'K C 1 <br /> T� ^ <br /> LEGAL DESCRIPTION(see tax receipt)PC L �I L 2 (Lo-r 25) T'Lf N IP,da S t v <br /> �EcTibN 2— <br /> DWELLING/BUILDING u, <br /> DWELLING/BUILDING ARAGE/ACCESSORY STRUCTURE ❑ ADDITION Lry PRIVY ❑ I� c o \ <br /> TYPE OF PERMIT(S): 1V <br /> Cr <br /> FILLING/GRADING El CAMPING NIT ❑ SUBDIVISION ❑ a <br /> D ecl� 5: <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Be room; Deck;etc.) w <br /> BUILDING CONTRACTOR: d W 04E�k INU <br /> E <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. rn 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 \ <br /> CL n, <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �(J Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I N 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. tJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. -0 (i <br /> ) <br /> o g p(- <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o !V <br /> NEEDED. <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z N <br /> CONDITIONS OF PERMIT: c �) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT SW <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 /> 'o fir 06. 0 � <br /> 1 In <br /> • m C a o S � <br /> 7. Z 'woo : ��c1 <br /> C <br /> 1U/: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <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 /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 liabil which may be a result of the County of Burnett relying on this information I am w <br /> providing in this lication. a ermit county officials charged with administering county ordinances or other <br /> authorized pers to pave ce to a ove described premises at any reasonable time for the purpose of inspection. <br /> T <br /> CD <br /> -3 �I " . <br /> SIGN HERE - d+ <br /> (signal re owne orb ilding contr (d te) <br /> ZONING ADMIN STRATOR rf <br /> VliC" 0NN <br /> O N (r <br /> TOWNSHIP PERMITS MAY BE REQUIRED �y�ti 66666 ' <br />