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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U O z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 3ya_ 7G 75 <br /> OWNER z Vv©aDRWR`l TELEPHONE QZ-5ZS--0(3/ n <br /> O <br /> m <br /> HOME ADDRESS (00/ '9 /j� <br /> e N <br /> T � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> z~yo-/6-4/6-o To l nrJe. /ices LJOT 7 (� <br /> LEGAL DESCRIPTION(see tax receipt) s2/L 2S SY3, 0 �/� 523�T`l0lx/bwRc,�ES <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> S. <br /> STRUCTURE/ADDITION USE: tm6e)z Kwr1� TO (-A k6 0 n ` <br /> m / abin; Commercial Business; Bedroom; Deck; etc.) Cn U) <br /> BUILDING CONTRACTOR: <br /> v <br /> Q <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ;a w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o Q <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO r6 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. P <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a 0 <br /> NEEDED. 6' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: <br /> G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> PB K REA. <br /> 5. ' <br /> (�4- � � 0 2<- '3 00ov <br /> In <br /> 6. V m � 3 CL(D W <br /> ! t a m c M N o s 3 <br /> 7. Z m m� <br /> o : <br /> Cn :Ct m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I 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 f County of Burnett relying on this information I am �y m <br /> providing in this application. I agree to permit county official ministering county ordinances or other m <br /> authorized person to have acces to the above descr" rem' y re i for the purpose of inspection. m <br /> SIGN HERE /C t/`' "I - C <br /> (signature of awn or uild'n o r) h;-AAR <br /> ate) <br /> ZONING ADMINISTRATOR ot cn <br /> N NU1NN (n (T <br /> a <br /> 7n.. (,^, 0000000 <br /> TOW SHIP PERMITS MAY 61�IY@/ pry ?-q <br />