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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N � <br /> OWNER 3%c Y/'C TELEPHONE 51 — 6 00/ Z o 'y <br /> // ` // n T hn l �T` l✓ m t. <br /> MAILINGADDRESS eCJ � KJ �� �1 ` /, me.✓i'475 /•�Gz44ZC -5/.20 <br /> �{ <br /> o <br /> r <br /> PROPERTYADDRESS -41,5176 ,LC/ sj�/gN p/L • I <br /> LEGAL DESCRIPTION(see tax receipt) .�/� - /✓W Sc�. 4. C2 m <br /> (p( (J� A <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION JLV " I rn o \ ` <br /> TYPE OF PERMIT(S): iT <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ a <br /> < <br /> �J� e f e9 ny <br /> STRUCTURE/ADDITION USE: [�f7 -Al � f 7 /won -a dgS + Cfa-0100�� � 93 <br /> (Home/Ca In; Commercial Business; Bedroom; Deck; etc.) W <br /> m � <br /> IS- <br /> BUILDING CONTRACTOR: A/Q/LT/i. lwAD c• U N <br /> � A <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T l� <br /> z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m xt <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NS)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m OQ 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. 1 P <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. Qf,i <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 OQ <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q � <br /> NEEDED. (fit <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Y� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C}t ( <br /> ISSUANCE. �'1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. t <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACKA. <br /> 5. DnSIREC7k- (It <br /> Wu Wr- Dvavv <br /> W c m d 0 m a f m <br /> 6. 0 x 3 n m x aM A <br /> oc N C N y O J 3 <br /> Z C N N O J O -A <br /> �. O N T� ° m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m — O <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n » N A <br /> all information contained in this application (including any accompanying schedule) and 1 further declare that I recognize O <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 1 am <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. 1e a <br /> m <br /> m D <br /> SIGN HERE /Ui.� / ' <br /> � 4. J/C✓! ��14//21 !^ 7 _Q.5 <br /> (sig ature of owner or�'building contractor) (date) 0 <br /> ZONING ADMINISTRATOR �J <br /> �sv w tN <br /> �fR fA EA(A" N <br /> C O N Ut W W N O <br /> O N O UI N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS RMIT SHALL EXPIRE ONE YEAR FRPM DATE OF ISSU NC <br /> F, <br /> - iy4trma'i " --.- iVor�t� 3�1ldefs <br />