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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> OWNERKGY e„ k Li, Pe.c Q k� TELEPHONE !j/Ste' �a S•—aG �� o 1 <br /> m <br /> t <br /> �. ¢ ) O <br /> HOME ADDRESS aZF �9?Sq S4 (`r'O i7+V ( (meq i I <br /> rCD <br /> O <br /> EMERGENCY/FIRE NUMBER alb �� ROAD NAME ,S a, C(16 i y TrGl 1 <br /> 10,000 ACI--fv <br /> LEGAL DESCRIPTION (see tax receipt) _g ' (j4f� i 7_3 _ Y S£ N <br /> CD <br /> ��/ ki <br /> ELLING/BUIL ING ® GE/ACCES Y STRUCTURE LYr ADDITION ❑ PRIVY ❑ N (n <br /> TYPE OF PERMIT(S): , { '( O a <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ +S-�Iti� a <br /> STRUCTURE/ADDITION USE: M AM7cAT'�L:-ToVJ'C� FFD/VV�i� •�D�l ¢�Htk't�W'^r � � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> 11v �s� _ FSI J <br /> BUILDING CONTRACTOR: P1 w <br /> era.p .�-i +-%'v-%'v s Crc-`v /s <br /> -o <br /> (D <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: ERIAL OR TOP VIEW) 0 0 ` <br /> n <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. I ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFlkLD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. C> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS RADEDr%OR FILLED. N ` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, I)t/ 0NTR TC.,THE PLANS I UJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. �`„/ v' O <br /> V O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO A ITE V�#�ICATION MAY I,:WHEN ° i <br /> NEEDED. Q U t 9nn (,_ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. URNF>7` � Z �) \ <br /> CONDITIONS OF PERMIT: 2ON/�O1JN� ° <br /> ((,� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER9T <br /> ISSUANCE. ( � d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ( h n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY f y� <br /> PERMITTED. / <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> C W D O D � m <br /> 6. m � anmOx <br /> 'O CD <br /> Z N (D O 10 <br /> 7. 0 : —n Z1 <br /> C/, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)2 : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize pp 1 9 Y ) 9 D 'm p <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> CD <br /> SIGN HERE <br /> (signature of owner r uild1 ontr / (date) <br /> ZONING ADMINISTRATOR ! ` —�-Z'IT <br /> TOWNSH PERMITS MAY BE REQUIRED q) Q <br /> V <br />