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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3• <br /> N O jN <br /> C <br /> OWNER / 17 d/' ,�4y A4 1��/ TELEPHONE <br /> 5-53 ROM bR=U(F ► 0 <br /> HOME ADDRESS /VeW RMoJ4/fidNI)1 LjX -54I6I I (/ CD <br /> EMERGENCY/FIRE NUMBER a r73q ✓ ROAD NAME �� DEU-ZL_S LIC. <br /> FILL O c 407' 2 AND %HE SCUT '101-774aT ioGOT . aF �RrsF�EO <br /> 5«.RVeY m A P, v»cu ME 4 PAGe i7 00ccz/4avr A"PtWR p <br /> LEGAL DESCRIPTION (see tax receipt) 15 (cl REG�-S7F.� O�c (�c�ps WX w v, <br /> c <br /> DWELLING/BUILDING D� GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y o <br /> c <br /> TYPE OF PERMIT(S): o- <br /> n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONS. <br /> _ ( T. <br /> STRUCTURE/ADDITION USE: ' <br /> 5Z Sa IV 4� y1 No F� 14�s� w r/UC��r o <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck;e c.) co <br /> BUILDING CONTRACTOR: CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �fL(/ �� /A� C,f}{/+J`�— 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ii �u��3i' O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCAT/ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). m <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. 1 <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. ttt��� N �l l <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0, Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. ' <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: QN. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Sv <br /> ISSUANCE. W �I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. x J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. coo M.m � co�iCCDCm <br /> m �3 . Ny <br /> 6. m o • 3 <br /> v C m . <br /> o <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O CID; CD O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J m <br /> sue a permit. 1 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. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have ccess to the above described premises at any reasonable time for the purpose of inspection. - <br /> CD <br /> M : <br /> �� M19ReN fie, �000 <br /> SIGN HERE date <br /> (sign ure of o r building contractor (date) <br /> ZONING ADMINISTRATOR <br /> wtncntnt»v+� <br /> .cNi, PN, o •1Nn �oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />