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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> yl/J\ ya o <br /> OWNER �� L�j— TELEPHONE ��5�`7 ,6 b-4(-V4 <br /> n <br /> o <br /> D Q ft' K' cy d <br /> MAILING ADDRESS 6 o v h � y �Q`'�'S�1�I-U � `�,� `� � O <br /> PROPERTY ADDRESS C I . ' 1 <br /> G r by `bh,p F do" � ' S"tt j <br /> L� �1 3lflbs� oc 3Y 7b 1 V oLl$' P d"'-7 <br /> LEGAL DESCRIPTION(see tax receipt) �f 7-An j % k-1i w -Ty� bi �C-t.- <br /> kt- mo <br /> DWELLING/BUILDING;K GARAGE/ACCESSORY STRUCTURE 9, <br /> ADDITION ❑ (n o <br /> TYPE OF PERMIT(S): l/ C <br /> ILLING/GRADING ❑ CAMPING UNIT S BDIVISION ❑ �y- y q <br /> y Y ,��y, `t,' <br /> STRUCTURE/ADDITION US 30 ( - -I� J lb-ILC r` T "` �r H <br /> o' <br /> -� (Home/Ca n; mmercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ONW LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> /0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> TZ <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ 03 <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),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. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS % <br /> MUST BE SIGNED AND DATED BY THE OWNER. n o <br /> V q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC Y o <br /> NEEDED. <br /> LJ p, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: APR 2 2 ° a <br /> 1 SSIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERBmRNE77 C LUUJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ZON�jVC.7 UN+ 'T, <br /> 1 <br /> IN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY o <br /> PERMITTED. _ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. A 0'r D0DO '9 <br /> 6. �IC_ Ip 3n00, 0mm <br /> O N C y y 0 <br /> 7. Z N O O to -{ <br /> M <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 1 am responsible for the detail and accuracy of 1� m C 'Cow. <br /> * 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- `D <br /> sue a permit. I further accept all liability whi ay be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to prmit cbpnty officials charged with administering county ordinances or other <br /> authorized person to haveVeQess to thea ove de ri d premises at any reasonable time for the purpose of inspection. '�^ <br /> CD o <br /> -aa� 3— <br /> SIGN HERE <br /> a : <br /> rure f own r building contractor / (date) <br /> ZONING ADMINISTRATOR ta.n� `PL/��� <br /> fA fA ER 49 N <br /> P0,01 <br /> 01 C.f n$ O, O (TNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED �tyX.fJ <br />