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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 /> " o <br /> N <br /> C <br /> 7� � � / (D <br /> OWNER � ph-e n k S TELEPHONE �Q S I - 31 FS- "/9 8 n <br /> a <br /> 1^ CY d s <br /> MAILING ADDRESS Q ©a v J L-O�, 1 1� CA �U JJ O <br /> 1 _01-)C✓ -e 00 m <br /> PROPERTYADDRESS �-�� 5 5eC . _ J L" WO• gr � <br /> Z)Co t:t Tak)✓N , r ne,ct C L� t 1 .� <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> 0 <br /> p� <br /> DWELLING/BUILDING LSI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): / �// ErL <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ /OY�(-Y <br /> STRUCTURE/ADDITIONUSE: Y111 - 3 <br /> q112Me/CaMDcommercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: d '� <br /> m <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. 0 m ^� <br /> 0 m C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> -n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE \ <br /> C V o <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. p 1 <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. n <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADE D. d N KJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, THE PLANS 0 C,G <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> / O 0 r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFf TION MeA BE D E ° <br /> NEEDED. VVV 41j6 �^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 8 Z <br /> CONDITIONS OF PERMIT: vR2 CO� 0 Z (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �vp/ a Nj�. iVi1 <br /> ZZ0i <br /> ISSUANCE. � W <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. of <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. _/ '�r '-W�t <br /> 5. „u�:.�- H�vt- r�u�sc !s4u� Lc Fc� E der �''�-e G=,.lrv����.v- /4�,drrc- U3 <br /> A cid DMD m <br /> (, N C ,yj, N 0 S 3 <br /> Z m N 0 <br /> 7. O T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to theabest of my = : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 Fn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : CD 0 o mt7 <br /> that this information 1 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access tothe abovedescribedpremises at any reasonable time for the purpose of inspection. CD Cn : <br /> m o : <br /> -c' ��/� 919103 <br /> D . <br /> SIGN HERE 819103 a <br /> (signator caner or building contracto (date) <br /> ZONING ADMINISTRATOR �( / ' <br /> C Eli fA fA M .-• N <br /> N ut N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED /V\(, <br />