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Burnett C,unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> /� d <br /> OWNER 6,/nat3r Ao,ar v�C TELEPHONE 803_A 9,!?_3�6y o yw <br /> / Q CD �J\ <br /> HOME ADDRESS [JOd LDe-P e C fa, s$4p /�o� zcr4 j n .SC a 90�/S' <br /> EMERGENCY/FIRE NUMBER �g7lo� ROAD NAMEQ��,.A 1<Jisr,a�-I&Ae. a� o <br /> aw <br /> LEGAL DESCRIPTION(see tax receipt) �l 3 C077 V. C Tzk.5 k JV c <br /> a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ElPRIVY El to 0 QQQ;,,, <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADIN ❑ MPING UNIT ❑ SU DIVI N ❑ n <br /> m <br /> STRUCTURE/ADDITION USE: 0 <br /> e/Cabi , Co ercial Business; Bedroom; Deck;etc.) N <br /> BUILDING CONTRACTOR: Q,t7 La 9 <br /> c <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> iI y � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `D <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n r <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 m �[ <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�l <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. 4 J\ <br /> "— <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa Qo <br /> NEEDED. _I <br /> � <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 �!J ) <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFIC Y <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITH ,WATER <br /> SETBACK AREA. �p <br /> li' m M.M. m d o (D a : m <br /> s. S '�(�( <br /> �i�_ e +?, (�� m. 3 n m ,0 <br /> � N C y N 0 = 3 <br /> 7 (/AN �� ymo <br /> . <br /> 'V a [ T'� z <br /> — N : A <br /> I declare that this application (including any accompanying schedule) has been ex�r 16 �,qle and to t t of my G� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am respon �4f(§r,�gtail a uracy of n T <br /> all information contained in this application(including an accompanyingschedule and I er�y,�� 1 reco nize <br /> PP f 9 Y ) �"'9" 9 I m p <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 nn ll m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other �'tJ <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m <br /> SIGN HERE D I <br /> ure o owne or building contractor / (dat ) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED �q <br /> d <br />