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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _U 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> OWNER TELEPHONE 716.3v <br /> L /n�``.��, � '�`nom.- <br /> MAILING ADDRESS 3 ly YUKoAl r4yer IU� A/r6 /0N 5'�yZ oy <br /> o <br /> PROPERTY ADDRESS 08P P+t+ /+A14 d;_ S Dit/ <br /> LEGAL DESCRIPTION(see tax receipt) y 3 Csm U l fbj /7 w <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ <br /> o <br /> /I n <br /> FILLING/GRADING,�❑ CAMPING UNIT El SUBDIVISION ❑ W <br /> STRUCTURE/ADDITION USE: 0�'-!1 Z /Z X d / <br /> �/ <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> RutsBUILDING CONTRACTOR: �7./L, T V t S bil�] U/ L A ee, <br /> '7 -_ - - � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> 03 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 3-3 �' O `m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m r" <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m I \ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> Zt <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. I I I `2 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADE ORFILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, C c R Tq. THE PLANS 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. J S o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF ATI ON MAY BE QO 1 A4 o <br /> �`' <br /> NEEDED. EY�,QR 0q � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. R `001 <br /> CONDITIONS OF PERMIT: 6UR�IE ( I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITZ N vo UN7y V _ C!5 <br /> ISSUANCE. <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 rr <br /> PERMITTED. W� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m w <br /> r- 0a0 <br /> m <br /> 6. 3nCD xnm <br /> (gyp W . O j 3 <br /> 7. Z N O : O 0 -I <br /> TG : 7J <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myC <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m O : (A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ` o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D <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. m co <br /> - o : <br /> SIGN HERE a <br /> ( ature o er or building ontractor) (date) XJ <br /> ZONING ADMINISTRATOR 1_nl <br /> N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �6597G <br /> N N <br /> /5-5-y/ N <br /> ozoa6-v 4'dd AWL <br />