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Burnett County 7410 Co. Rd. K, NO. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> E yV <br /> N <br /> .s� 0OWNER TELEPHONE -3Lfrj_ y�ti a o <br /> ;: 00 <br /> HOME ADDRESS OC <br /> AIS �k)p S ,rue 1f Old Tryon r. .c pArj 550,.6 <br /> EMERGENCY/FIRE NUMBER ROAD NAME !:)e <br /> y �ILbJ 345 t`f�C/1 J c)c�3 Pam4k <br /> 0 P' �t Ac"60-r tc V.LEGAL DESCRIPTION(see tax receipt) S / T�)O/RAS P4�.f4o t�Ic1 <br /> DWELLING/BUILDING I� GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn n <br /> c <br /> TYPE OF PERMIT(S): CL <br /> v <br /> 0 <br /> FILLING/GRADING E] CAMPINGUNIT ❑ SUBDIVISION ❑ S <br /> STRUCTURE/ADDITION USE: h i^ o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> BUILDING CONTRACTOR: W &Qi kX bf CuL CL& Car <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) In a <br /> n O Z <br /> �1. ALL REQUIRED Dlx'Fr�Sl�DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> �. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). W <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m v,) c <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. C <br /> <` SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> n16. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o \3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN S qj <br /> NEEDED. <br /> C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: II nn <br /> vI <br /> �A. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> y.-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) 7�/ <br /> ETBACK AREA. ; // J <br /> 5. V �5 zvc)= CDOCov <br /> M` ����JJI ( < p CL M Ow <br /> N i � CL rn <br /> fD � DC:WW � 3 <br /> 6. - e i Z ; y COD o o t <br /> 7. BUR Cn € i m <br /> I declare that this application (including any accompanying schedule) has been examinedy�y, a tR�thR,b� my 0: c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible l a ccuracy of o o <br /> m m <br /> all information contained in this application(including any accompanying schedule)and I further de are that I recognize v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 o <br /> CD <br /> authorized person to have access to the above d_iscribed ises at any reasonable time for the purpose of inspection. <br /> m : <br /> St <br /> (signat r of owner or building c rac di <br /> ZONING ADMI STRATOR <br /> � cNn0o "i+Pi �oo <br /> 0000000 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 00 0 <br />