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ON COMPUTERISCANNED <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 1 c, CD <br /> N � <br /> OWNER �^ R - I (� t� JO Y-1 TELEPHONE �� ' a L � C�U�/ n <br /> Ck 8► C 7 Yl o <br /> G <br /> MAILINGADDRESS �° D� PSA i2« �d(1� 1/` ) �� Sh o i-e U I J(-Z, MAIV 45 /� <br /> co / <br /> PROPERTY ADDRESS m <br /> 55 �o�- � rim tQ lc�[�L' rt"YZ� I L -��n�ju.r2u , L(U I <br /> see tax receipt)LEGAL DESCRIPTION( pt) CSS (I l'? /9/ /4 8 - t�-« <br /> (( m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ (� <br /> TYPE OF PERMIT(S): `v <br /> FILLING/GRADING ❑ CAMPIN UNIT ❑ SUBDIVI N ❑ <br /> STRUCTURE/ADDITION USE: P_/Y X U <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: u <br /> � 1 <br /> v ' <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. m <br /> -A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a C N <br /> m <br /> MZ V <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 9 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF f 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. IN <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 /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. �[ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J i �(L u o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS F PER I <br /> ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG Sg QR�ELIN . 8 2�n3 <br /> � <br /> 3 NO GRADING <br /> OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICIALYRNETTOOUNTY <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUII?RQ {NG <br /> SETBACK AREA. <br /> 5. <br /> X 0 >0 > 0M <br /> CD ddomam <br /> 6. $ am 0nm <br /> ry C y N O <br /> 7. Z N fD O 'O <br /> 0 :�Q �l <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 1Q d ; cn c <br /> a 0 : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m omo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> ( : <br /> SIGN HERE (IzXqq 00_� � � <br /> n : <br /> ( n ure of owner b ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> �yfA EA fA di 0 N <br /> cn0 (n Cn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED io <br /> ""L' Icd i <br /> q-aa -Q3 <br />