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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 01NNER J u a�n . E-ze J UA;e/ TELEPHONE <br /> O <br /> MAILING ADDRESS — q4 . Q� .SQ,0 Ab 5 �� •j j o t/n <br /> r m <br /> PROPERTY ADDRESS,:5�f 7X 5-4L& -4�'w 7O &ta-'�5&4 - tlezL <br /> lit 4u 4-i-aa s 7.G <br /> LEGAL DESCRIPTION(see tax receipt) 3-39- /4i-3G -O m /goo Pa r, L O M <br /> LP <br /> DWELLING/RUILDNIG X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION y <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5. - <br /> U <br /> STRUCTURE/ADDITION USE: �'yJ e/ 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: 'P�A4Z Z �� y�I S m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INC m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) - T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. '`� '" j m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW B IN S(NB;,AAN wCwA.T <br /> NORTH(N). ( ) d�ut �r m z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) o <br /> CENTERLINE OF ROAD,(C)BUILDINGS MEASUREMENT TO THE ORDINARY HIGH WATER M) <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. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRA 2TSJ FTC.,THE PLANS o � <br /> MUST BE SIGNED AND DATED BY THE OWNER. (� <br /> WANOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED Y B $ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW MAY ' 2 2M3� DAP <br /> 6 20 \ o <br /> CONDITIONS OF PERMIT: BB11'' V V' Op <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WR �YCw 20N�COIJN <br /> ISSUANCE. ONIN N� ` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG ORELINE. ((�� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRE ATER }��(J <br /> SETBACK AREA. 1 V (nA�n& X/) <br /> 5. No 6!/'q,dihz lu1H\ 1„- cSU I �� Q /�W/rt G� i (/N iwl f CUJfVJ <br /> 0 m 0r <br /> � � DO � <br /> m <br /> 6. R 3CaS M <br /> L ry C <br /> 7. Z N ry O <br /> o ziI�2 ' m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my G7 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 2 `. -0-,all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mo <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <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 <br /> P 9 � PP 9 P ty 9 9 ty �c <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> SIGN HERE - `0� <br /> n <br /> sigre of w r or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N <br /> N <br /> C" N N O O <br /> OtO(T tn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />