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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator r" 7 - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> //yyJJ // //// D -7<S-6357-yoljo <br /> OWNER ZARky C /)!/C4e//e /tI/S ✓LJ TELEPHONE S-07- 299` !J 7Z... O \' <br /> HOME ADDRESS -312- /ry<_ / /N A1)0C Lr-5r" 14&. <br /> CD <br /> EMERGENCY/FIRE NUMBER 13ro ROAD NAME CouNn/ �15 /T <br /> LEGAL DESCRIPTION (see tax receipt)- d` �ys,. A,c,ee- 407-OZ4 <br /> W <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ cn 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ C MPING UNIT ❑ SUBDIVISION ❑ <br /> ham, �N <br /> STRUCTURE/ADDITION USE:� D CA9//V JW 1Him -3)X-ego o <br /> (Home/Cabin; Commercial Busine ; Bedroom; Deck;etc.) 0J <br /> BUILDING CONTRACTOR: <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 C^ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> .Z1 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). to 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. 9 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. I o <br /> CV o J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN �- <br /> NEEDED. <br /> C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o j <br /> CONDITIONS OF PERMIT: c <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 SPECIFICALLS Q <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE RE I T7 <br /> SETBACK AREA. <br /> 5. /LT(�ty� l <br /> MC) rDOD09 <br /> m d o m n * m <br /> 6. jut 2 b tour � 3 a CD a 3 <br /> (DC: , . 0 0 <br /> 7. B:1Ry -n <br /> - N : m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me rjrny m A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the Gaccuracy of W 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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. 1 agree to permit county officials charged with administering county ordinances or other vu. o <br /> authorized person ave access to the above described premises at any reasonable time for the purpose of inspection. m <br /> T <br /> N <br /> SIGN HE I - y <br /> (signature of o ner or lldi g contractor) (date) <br /> I al4 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />