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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U ci z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> VT O <br /> N <br /> OWNER 4 Gp,+�erivtI hhNt(' TELEPHONE <br /> / <br /> HOME ADDRESS '74 7Y LOrCNCL WayX�to1 erl_ <br /> EMERGENCY/FIRE NUMBER 1 q( (;ZA s Ro 1G ROAD NAME S Y,Ces 15o,+,l 1 <br /> LEGAL DESCRIPTION see tax receipt)( p) �/ir�uf'Gov:T. Lei !i to/5 3 �1 S£ Sec- /D T2/o.,-R/yW, (� <br /> CO <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N o <br /> TYPE OF PERMIT(S): c ' <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a . <br /> STRUCTURE/ADDITION USE: LFMiN/Add r2 aAW A�" M#-P o' � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn U <br /> d <br /> BUILDING CONTRACTOR: /Nei✓e <br /> d <br /> M <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. -n <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `m <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. f7 m �• <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). a <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 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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V TI 3 f�IEN g <br /> NEEDED. <br /> � � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. q o d <br /> CONDITIONS OF PERMIT: ZOO2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS(913FWET <br /> ISSUANCE. C� CiOUNTY <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREIZONING <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. Q) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. �/ <br /> �( I 1� <br /> aflD <br /> 6. 0�/�- P' C��1 0Y) (0 m � � 0 ooaf m <br /> �dXIIYlI( !71 m.� � 'amxaM � <br /> r N C y N 0 = 3 <br /> 7. �Uo 1 VIN Or l -F e �7re in rOO4 o " -9 ' <br /> Cnrn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j ' G) A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of /✓ : m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize j 1+ M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �(V) O <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 to the above described premises at any reasonable time for the purpose of inspection. .n <br /> M <br /> ////j m <br /> SIGN HEREPSlt,/!' . Lyzl <br /> isignaturiVolf owner or building contractor) (date) <br /> ZONING ADMINISTRATOR am r 1x711(/ g N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />