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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 /> N O <br /> OWNER I j m - p � TELEPHONECD <br /> ( -�]'_Lj <br /> Imo? �t� n7rl I,� QI <br /> HOME ADDRESS �'y�, � �`u� 5��� <br /> EMERGENCY/FIRE NUMBER .3666- ROAADD NAME�el9by d, 043 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 7 r - � 00- Q V ur <br /> 400) T*c_kSv Ola <br /> o -- ya.�a3-�'De.-.,, 450 <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE El ADDITION D4 PRIVY ❑ N 0 <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> N <br /> STRUCTURE/ADDITION USE: o' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m r <br /> NoA► �P �►�,�1 <br /> BUILDING CONTRACTOR: A e'►^EGIXI nlC. KhWt tJ�f r .( 2. Q <br /> Qi 6</".5- 5_ - a l/1 � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (7 m 1-11� ;p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD W <br /> NORTH(N). W o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. c <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS OO 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 o t <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq 0 <br /> NEEDED. 0 <br /> ti <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: Q <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 4�1 <br /> PERMITTED. OO <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;a -V 0 v o <br /> 6. m CL' m <br /> MCm `" os3 <br /> . o y � <br /> 7 •< : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj c 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize I o (D . <br /> 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 of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to accesIp to tjvMabove described premises at any reasonable time for the purpose of inspection. m E <br /> m : <br /> SIGN HERE —CI) —0✓ <br /> sig ure o or building contractor) (date) rv,7 <br /> ZONING ADMINISTRATOR w <br /> ^ 444A�M'A469 ift, <br /> N N <br /> N N P N En <br /> P <br /> % VtN 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED q f �3� 0 0 0 0 0 0 0 <br /> 0000000 <br />