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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - °oo <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> T <br /> OWNER Q KLQAlE 14)4 / /T TELEPHONE( <br /> i � m <br /> HOME ADDRESS / grr<s Alre-e—Aj 8ily &47- ,SY,30y v o <br /> EMERGENCY/FIRE NUMBERl�aS CD <br /> �p�N�y ROAD NAME�VN /A-. 1 rt (� <br /> LEGAL DESCRIPTION(see tax receipt) I \- <br /> ^ m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIW ❑ V' ur 0 <br /> TYPE OF PERMIT(S): U v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: /' om,e. !C r/4:ZC_ 1170 Se, >�t ��$X66) In <br /> o � <br /> �yy•-- (Kome/Cabin; Comrr(erciall BIlsiness; Bedroom; Dok;etc.) m <br /> 1 <br /> BUILDING CONTRACTOR: �Tery-y oA Dzoy k ( Q& e'�;v 5- ',VL 7elen <br /> 'c ^\ <br /> T � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> c fZ <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) T a <br /> fi Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d , <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n I <br /> NORTH(N). <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. O(L 4 o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I C>1 <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. Cot <br /> o <br /> ) o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> Ct <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P (> <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY fj I QJ N <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER V I <br /> SETBACK AREA. G'�ue'�- <br /> r <br /> m �. md , m m <br /> DCHo � M <br /> 7. <br /> o .0 <br /> 'r <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my \ p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m i <br /> SIGN HERE YA,L <br /> (signatur wner I contractor) / (date) <br /> ZONING ADMINISTRATOR /gyp . . . . <br /> v+fn to to cnw� <br /> - N Nl11NNfl1N <br /> Vt Ut O Ut V1 O O <br /> OWNSHIP PERMITS MAY BE REQUIRED070 0 0 0 0 0 0 <br /> ,0000000 <br />