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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 Q Z <br /> APPLICATION FOR LAND USE PERMITS 3 ` <br /> Tio <br /> OWNER RItC- V 4hr4SF,-,j TELEPHONE 763 68Z—IZ)38 <br /> CD <br /> HOME ADDRESS 411 Divi.cm G� TIIAq)o MN 55313 CD <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME STATE Q,D 35 <br /> TowNswiFC41) NOasH c <br /> LEGAL DESCRIPTION (see tax receipt sW► SW t seetl'w Z-7 RAiIj&L Cf.) WEST=q0U ,s { �� M <br /> 0 <br /> DWELLING/BUILDI G ❑ GARAGE/ACCESSORY STRUCTURE Z ADDITION ❑ PRIVY ❑ Cl) O <br /> TYPE OF PERMIT(S): �1 ' <br /> FILLING/GRADING ❑ COMPING UNIT ❑ SUBDIVISION ❑ Q} n , !�+ <br /> STRUCTURE/ADDITION USE: 2$1 &LO.s f 6 RIAr.E vbiZ S'7nRA6E <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> pn�Q� <br /> nn m <br /> BUILDING CONTRACTOR: S6 LF &J 17 1nI d <br /> 30 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED T <br /> O <br /> ;G N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AE RIAL OR TOP VIEW) O CD <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a m 1 <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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASURMENT TO WETLAND AREAS. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W)f 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 BE4�R <br /> D. IV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER,BUILPLANS 0 <br /> MUST BE SIGNED AND DATED BY THE O NER. i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS UST BE STAKED SO AN ONSITE VATIOIj�IdAY BE DON WH€N <br /> NEEDED. J�(% <br /> 630 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e�fR Z <br /> CONDITIONS OF PERMIT: Na ' T E7T COUNo <br /> T' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WID H REQUIREMENTS WITHIN 60 DAYS OF PERMIT7'01V ' <br /> yj <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND EGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATI NS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININ 3 WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD - Dpi m O <D n f rrnn <br /> 6. COD 3 n CO 0 m ,'0 <br /> y CD CD O 1 <br /> 7. O TI <br /> - � : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myr` �, G) A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of "'" Q ^ - <br /> all information contained in this application(i icluding any accompanying schedule)and I further declare that I recognize <br /> CD p <br /> that this information I am providing will be re led 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 6 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m `D <br /> CD <br /> CD <br /> SIGN HERE L4UW J& PI R/30/oZ� <br /> (signature of o c r or building contractor) T�(date) 'N <br /> ZONING ADMINISTRATOR /& v) <br /> TOWNSHIP PERMITS MAY BE REQUIRED /�� U <br />