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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 /> 57 O Q) <br /> OWNER J hJJ e 7 dal L� TELEPHONE 952g9l - / V j ) ' , <br /> j� ,/►� (m O <br /> MAILING ADDRESS 1 6 1 7 2 H L ru,-J C 'J u�T L"cy'o u c W r <br /> n (} ' O <br /> PROPERTY ADDRESS Q33 IC�d Fo x 7 i- Y4 PaN r-\urN LJ 1 k <br /> /2 1, I <br /> LEGAL DESCRIPTION(see tax receipt) LS /Sed � /{� 1X l l '(�QWay l d— `f'—1 � M <br /> DWELLING/BUILDING C9 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CPO <br /> UNIT ❑ SUBDIVISION <br /> / ❑ f a X � 1'C� ^� <br /> STRUCTURE/ADDITION USE: I �O M� rp�7 7 � � �X/a <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) C <br /> (Y\ &LK L;Nsc, c �4 �« �3 , <br /> BUILDING CONTRACTOR: i <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9t A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF n)` o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. XJ <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRAD e <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, C7C..-THE PLANS pp`` <br /> MUST BE SIGNED AND DATED BY THE OWNER. ! r .c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF�ATION/ft§E E DONE 4w- -' o <br /> NEEDED. 4//�{ , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ������ C' `O�✓ /l1. P O_ <br /> CONDITIONS OF PERMIT: <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 Q (n fes) <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ( , <br /> SETBACKAAREA, V" <br /> 5. <br /> M m <br /> W. 0 Ono V <br /> W. <br /> 6. �O <br /> 3 � � nm M <br /> CL <br /> Z y 0 0 O <br /> 7. O . < <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c' ID <br /> W: <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> n 2 - <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �: m 0 : 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 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. oCD <br /> : <br /> 7 m m <br /> SIGN HERE ✓ —�Y-c'3 a <br /> (signature of ownerr uil c ) _jdatA <br /> ZONING ADMINISTRATOR 3102-7163 <br /> 3 fn d+ER di� N <br /> G CNnON(TOO <br /> TOWN IP PERMITS MAY BE REQUIRED Q n� <br /> „t�9�'II -�trilkS <br />