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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - °CD oo <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> OWNER C.e•4�G /Q+� lJ�i��7�%f�y TELEPHONE <br /> HOME ADDRESS ��77 46x4 vA�#/ ke, N. �1�'c4/�DH/v S�"D�l/ D OZ_ <br /> EMERGENCY/FIRE NUMBER ��yQ,E 8�g6 ROAD NAMEWi*a�&j 4e1UE�", m <br /> htl5rd .Y g3g141S S G 7 r4o kfl6 W AG&S'k , <br /> LEGAL DESCRIPTION(see tax receipt) RVyaj-e aw-< AeT? 14^^r h &#z <br /> „ry 4*Y. <br /> y `~ <br /> a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ A ti <br /> TYPE OF PERMIT(S): �—�/ <br /> FILLING/GRADING L� CAMPING UNIT ❑ SUBDIVISIONy❑rr^•�_, <br /> STRUCTURE/ADDITION USE: 00y .�ir .S/lN�s �� �/ (Qfj� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> � <br /> O-_/1/i m <br /> BUILDING CONTRACTOR: e?ZtCn` G! c �—B <br /> m Gn <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n o. <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) J 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. (� , 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. Y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. r N <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. R to <br /> o <br /> Z1` o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 -� <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 2 I' <br /> CONDITIONS OF PERMIT: o C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` W � 1 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> C . d Rg m <br /> cCUD' to <br /> v o 3 <br /> o <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m . . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Iy�✓' O <br /> sue a permit. I further accept all liability which may be a result of the Count of ' ormation I am I d <br /> providing in this application. I agree to permit county officials charged wrilwakI t ci finces or other m <br /> authorized person to have access to the above described premises at any t p of inspection. m <br /> i <br /> 142--r <br /> m <br /> SIGN HERE <br /> (signature of:r orr building contractor) R L ( e Q <br /> ZONING ADMINISTRATOR ! I k l 1� SURNETTG NTM Ci i i <br /> to w Ln v+w w� <br /> N NNNN'A V <br /> TOWNSHIP PERMITS MAY BE REQUIREZONING p{(� S 3 U0 0 o 0 0 o 0 <br /> f\" 0 000000 <br /> 0000000 <br /> l�U�� f3�� r1 <br />