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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 /> y O <br /> OWNER / FJ t 7 -ril 1�Vl 4{/ 1 7/LW/TELEPHONE /!iJ'(Y J J 'O !/.3 O <br /> � A m <br /> MAILINGADDRESS .7trazl,( /V` C'�r_141 -Zl` �� s '�a,�Ex o <br /> �! <br /> PROPERTY ADDRESS <br /> st w <br /> LEGAL DESCRIPTION(see tax receipt) Sym sw yY y) /(,�/IVY <br /> �" A <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ N ro <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO ❑ <br /> 1J � v41 T.r���c �T. <br /> STRUCTURE/ADDITION USE: aa4/i E ")y /' W t l h S, 0 _ <br /> nn �,y y r,(�Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m (} i <br /> BUILDING CONTRACTOR: AMF_ Ale. -AN <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> ° - J <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) p C <br /> n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tn � A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ; <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(5)TO ALL LOT LINES,(B)BUILDING(S)TO m ,�3 <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. Z= �..1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, I 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. <br /> v o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> n f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> r <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. (z) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C/ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. I i1 0' -7 / e. I , / <br /> 5. 5 �1+� I-Aolal ome N LlelywI� C. If 11 (�Irk&4 f F�'Gh <br /> w C� A wor DOD09 <br /> 6. /111 ,�53LLc.. a.Q DA'I- r0i a W M 0 M a F m <br /> m �c3 am 0a A <br /> om Cy .`^ o � �+ <br /> 7. Z o <br /> 0 m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my G1 O <br /> PP ( 9 Y ) Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v cn N ! C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 o <br /> or other <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances <br /> u . <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> D t <br /> SIGN HERE <br /> f» n <br /> (at at of ow r building contractor) (date) o <br /> ZONING ADMINISTRATOR 1j /j <br /> . <br /> G . . <br /> fA lfl d1 fq� N <br /> �O (Nl O l�li N N O <br /> TO NSHIP PERMITS MAY BE REQUIRED ry <br /> THIS PERMIT-SHALL EPIRE NE YAR FROM RAT OF ISS ANCE <br /> Yf <br /> mt' � a' � IYtel 40 �'fnye,( i0uls I�a3� D6 <br />