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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U ci <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> j hc1C' LW4—, z, <br /> o <br /> y O <br /> C <br /> OWNER <br /> (��1J1hnJi' RZc27a TELEPHONE �/S� Q6 —O 0 ✓ n <br /> v Q� <br /> MAILING ADDRESS v <br /> O <br /> ^ / ►tF 9 j Oh�e rs L k IZd �V�,QS�E,� S gq 11� <br /> '�U r m <br /> q_ / 0 <br /> PROPERTYADDRESSe--h G/rK6 , <br /> /U /N <br /> LEGAL DESCRIPTION(see tax receipt) �� JV� (' /�� r�� 9 <br /> y ��JJ <br /> DWELLING/BUILDING IYJ GARAGE/ACCESCS.00RY`St/R TURE CJ ADDITION ❑ /'j]�( �C,�� 1 0 <br /> TYPE OF PERMIT(S): 7 �, a <br /> Cr <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVI ION ❑ r 2. <br /> � �,-� y r <br /> STRUCTURE/ADDITIONQSE: C) t 1� J� 9 CG YQ S� 3 o \V^\I <br /> (Home/ abin; Commercial Business; Bedr ; Deck;etc.) N <br /> BUILDING CONTRACTOR: _"j2 U>'}/JC -7— 'j � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE ORrNi <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT 3 <br /> z C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n <br /> T o- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> n v A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S— <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 N <br /> MUST BE SIGNED AND DATED BY THE OWNER. C ° I <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT'il(?�QJ� DANE WHEN <br /> NEEDED. J1I � j W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ;( v V Z z <br /> CONDITIONS OF PERMIT: f �fj ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF kT719 <br /> NZ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELICpU <br /> 3 NO GRADING <br /> ED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �VI/�C iII�, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m° W 0, nF m <br /> 3 p x <br /> $ n ( °' �D <br /> N <br /> 7. Z (D O <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n c: <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- fD <br /> sue a permit. 1 further accept all liability which ma be a result of the County of Burnett relying on this information I a o0 <br /> providing in this application. I agree permit c my officials charged with administering county ordinances or other m <br /> authorized person to h e access to he above d cribed prafnises at any reasonable time for the purpose of inspection. m ? <br /> CDCD a <br /> o : <br /> SIGN HERE <br /> (signature of r bYdding contracn <br /> (date) <br /> ZONING ADMINISTRATOR l ` (�J <br /> � " fA fA EAW — N <br /> I? �I ��////��� N (n N N O O <br /> hIpIX <br /> TOWNSHIP PERMITS MAY BE REQUIRED (/1 (TO ( 000 <br /> Y <br />