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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> r o / <br /> N 0 N <br /> IN <br /> OWNER Ah�"r i c�c d' kdre r, yaQn B-e-e k TELEPHONE q 5 z_ g 9 g - 19 2 a s <br /> MAILING ADDRESS N4 e— So—'-RL1rnSJI lie, rnn ss 3c) <br /> PROPERTY ADDRESS V5 4 2-5 �AAm L,gk� ���aNL)UryI W I <br /> LEGAL DESCRIPTION(see tax receipt) 1. <br /> t�(I^k �� CjnY} 10` 2t 71-VoWnskp 40 <br /> 9c 15 WeS� ' <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITIONn o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a }lam\ <br /> STRUCTURE/ADDITIONQSE: cooi n0/ 6 �. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) co <br /> ° <br /> BUILDING CONTRACTOR: Se if <br /> M c <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'r l�G <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> T 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 /> 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 <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. 7' 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. S) 0 4 j <br /> M HEN X10 ' r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VVIERVIER � ar I <br /> NEEDED. l �J � �j� o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �" s IVV/ o <br /> CONDITIONS OF PERMIT: ? 0 <br /> pp J I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF�P Q, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELBN40�VG UAII l <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININ/J WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 1 <br /> SETBACK AI.Cr. <br /> 5. <br /> A o r D O D O � <br /> -O N C Nj N O j 3 <br /> 7. z N m o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of iv 0 �» <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D 0 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �' ' <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 v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to havp acAess to the above descr!pdd premises at any reasonable time for the purpose of inspection. m cl) <br /> o : <br /> m m <br /> SIGN HERE <br /> Z <br /> atu of owner or building`o 1 <br /> /ctor) (date - - n <br /> ZONING ADMINISTRATOR � <br /> TOWNSHIP PERMITS MAY BE REQUIRED W 7y V N 0 0 <br />