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i L <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER TELEPHONE <br /> O <br /> HOME ADDRESS /yG� r�G�r Trd S�vy•� •- S`�U 9 <br /> EMERGENCY/FIRE NUMBER ROAD NAME /)ee/ T/—a/ <br /> LEGAL DESCRIPTION(see tax receipt) ' �lJ C <br /> DWELLING/BUILDING 9 GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ElPRIPRIVY [:10 <br /> fn � <br /> TYPE OF PERMIT(S): ^'\cc <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S//UBDIVISION ❑ "CJS <br /> T. <br /> STRUCTURE/ADDITION USE: daoy7E? /C0 Q//K/ C:� X 310 0 <br /> //// [ (Homme/C in; Commercial Business; Bedroom; Deck;etc.) co <br /> BUILDING CONTRACTOR:�'C r 17 <br /> v <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. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 MCL Jj ,y <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 IF <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ki c <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 "U <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. m o ) <br /> °4 0 UN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. (n C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. E �� „ ,. D <br /> s ,C,L�O►^&land gra d7coo7yerra&AI <br /> to 6e correGfed 41`2h�a '(�r�ov (-7�l�Js� as(Ira <br /> (J�Zp/d <br /> �/�' 3 a %Q= m <br /> L/j , Z y MQ i <br /> o Vi .m. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize m m m <br /> PP (� 9 Y ) 9 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- E 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 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 the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> m : <br /> in <br /> SIGN HERE ^+ a K// 7-3d JT- <br /> (Sig d"(sigI ;o fr6ror uil c n ctor) �y (date) <br /> ZONING ADMINISTRATOR <br /> 16940'A40IM�69� <br /> N NNNNfn(n <br /> N Vt0 (J (TOO <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />