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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -I 0 o <br /> APPLICATION FOR LAND USE PERMITS CD 0 3. <br /> r <br /> y O <br /> N <br /> C <br /> q N <br /> OWNER e.Ue. rJ 0Yvls,S TELEPHONE <br /> HOME ADDRESS C A 1401:5 70 ,_ -S48 <br /> -,r <br /> �o CD <br /> EMERGENCY/FIRE NUMBER c7 S�5 ROAD NAME .4N/4L-6S 70 1 <br /> dl -C1 95 /tine 58 6 /Sze <br /> LEGAL DESCRIPTION(see tax receipt) a)a /T �$ -� Rvtw 50' :03 _ g'!7-L(-(0 Cn <br /> CD0 <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 0 y0 <br /> � 11 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a, <br /> STRUCTURE/ADDITION USE: IL&4D (,!41 <br /> 0 <br /> W0-46A <br /> (H me/Cabin; Co merclal Business; edroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: _ Br'O7 h¢,TS' l rr�/t S�iy�ypyJ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 77 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. - <br /> �rlc% 2 shQ,e fs <br /> 00 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) p <br /> in n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 A <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 CO) <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. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <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. f° °O ` <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z i <br /> CONDITIONS OF PERMIT: o Q <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. � OI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r`JJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. �t /� �QQ / \ <br /> 5.� X �` �Q.( `� "t" / Qom/ r `L�jAe G2 /" <br /> CD M. m m 0 m <br /> 6. m � 3 'amxa M <br /> nl C H N > > <br /> 7. Z H W O O <br /> M <br /> _Cn: m <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 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 liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> CD <br /> authorized perso to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> (o <br /> SIGN HERE <br /> (s gn f o r or building contra or (date) <br /> ZONING ADMINISTRATOR <br /> ' <br /> 4011A404a'� <br /> N " M NN MEn <br /> (T VtOfr Un OO <br /> TO SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />