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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O O <br /> C <br /> Icy- <br /> OWNER FA AZ �11L!jyln TELEPHONE I 23�O• 33 { v <br /> MAILINGADDRESS <br /> PROPERTY ADDRESS L) V �(vy+ <br /> LEGAL DESCRIPTION(see tax receipt) - BVI �(�"t' C� Zn <br /> 'vZ-II <br /> DWELLINGIBU[LDIN GARAGE/ACCESSORY STRUCTURE E] ADDITION El -{���h �� N 4, <br /> T <br /> TYPE OF PERMIT(S). nAaQ.t-,�Lk n ry <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < v <br /> STRUCTURE/ADDITION USE: AI ✓� 0 Y . <br /> (HomelCabin; Commercial Business; Bedroom; Deck; etc.) d <br /> Ql- <br /> BUILDING CONTRACTOR: E <br /> ✓ C, T 5 � <br /> A PLOT PLAN MUST BE PROVIDED OAT LEAST AN 8Y,X II SH ET OF PAPER. ANY INCOMPLETE OR 3 f �- <br /> ILLEGIBLE PLOT PLANS WILL BE RET NED. Z / T = W ' <br /> See var< gJ 7 ° V J <br /> ��p�� A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) """-Z n \ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n M A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). rcn \ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> �3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF +. �V Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. \ ° <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 W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 r� <br /> MUST BE SIGNED AND DATED BY THE OWNER. f -!)— <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN = ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �1 <br /> CONDITIONS OF PERMIT: d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 '1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY CY <br /> PERMITTED. !vl, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m c� ydrDi n <br /> MMT <br /> n o o n o a m <br /> 6. <br /> 0 omCy .`" o � 3 <br /> 7. o m w T'0 _ m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - ^' '^ D <br /> PP C 9 Y ) Y Y t7 � v : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including an accompanyingschedule and I further declare that I reco nize m ` m <br /> PP ( 9 Y ) g <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m o <br /> providing in this application. I agree to permit co my officials charged with administering county ordinances or other <br /> authorized perso have acess h bove d scribed premises at any reasonable i <br /> m <br /> D <br /> SIGN HERE <br /> n : <br /> at re of owner u ding contractor) ate) <br /> ZONING ADMINISTRA R 0c,I T <br /> TOWNSHIP I �} D I <br /> PERMITS MAY <br /> BEREQUIRED BURNETT COUNTi <br /> /' c <br /> THIS PELMA m f-- �XC� fyla IG ©"/ <br />