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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> V1 <br /> OWNER �t ,� [{'- �Ir NLr MSV TELEPHONE (pS l�� O ` 1O� /� CL <br /> m <br /> Q I_ m. <br /> HOMEADDRESS zZap E)r, qc-w �, �- pew l)2tc Y14DiJ SSI! -2 <br /> r m <br /> EMERGENCY/FIRE NUMBER 'Z-V3901 ROAD NAME Roo!Wj btke_ ,fid o <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) � <br /> \ <br /> �ael)oNs Wa&f +waorls 5r6 Lb + 3,Li, S � <br /> n <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El PRIVY 1:1 (n 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: co"6:N 0 <br /> (//Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: O� <br /> ky lathes wT 0 f?231Z.Z � "1 <br /> (oIZ- 1 re) - / toy/ Y,33- S2_ <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. <br /> tW <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -na <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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 TAIC�S�G_•_-,- I <br /> BUILDINGS, ROADS,LAKE,LOT LINES. L <br /> i,5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GR ED. ) o Oa <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER, OR,ETC.,THE PLANS �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ® o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE I ATION MAY BE DONE WHENq o, J <br /> NEEDED. BURNETT COUNTY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ZONING c ' <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n) <br /> ISSUANCE. 1Ci <br /> 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 REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> �� zvc1� oov <br /> 6. �iE f! T� �fi 1�2 I✓�nGn e 3 ' m <br /> � � � n Q0 <br /> = >, <br /> N C 0 i G <br /> 7. Z ' m (D <br /> O <br /> _•rn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <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 KN m O <br /> 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 ' d <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 Ahe above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HERE G`� )*)- <br /> (sign <br /> at o ner or building contractor (date) <br /> ZONING ADMINISTRATOR <br /> N <br /> i n CA CA <br /> (TCN N V7 <br /> OfT Ut O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />