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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 /> _ a <br /> 57 0 <br /> OWNER JON S. I IRU�.I L,E IJV, TELEPHONE q'(op.�-7, P.7( R� v V� <br /> Iv � <br /> MAILING ADDRESS LA i4/J&Qt (,J/ 5 (v� O <br /> PROPERTYADDRESS g4p� tDA2K ST. CJ U�nJau�2� lJ t S`�83 ; �^ <br /> PCL OoUIT- LOT Z �j��L}T€� w <br /> LEGAL DESCRIPTION(see tax receipt) `fo ti.J �17 Lj <F'f- O3 r qi�> W <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION 7EaD ' a to o �l <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ JI tJGG�. ('\ <br /> STRUCTURE/ADDITION USE: C-3f},e AGE /-�'y,o f{s(J�� AOOi>i0 ✓ Je47M,Ll✓4l% ? QJ a <br /> J (Home/Cabin; Commercial Business;Bedroom; DeckeEc.) l (n Q) <br /> BUILDING CONTRACTOR: r/ 6 nl E p L�.JC — -�8 N/C� T-I�t1 H&'OE- , d <br /> v / <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> j <br /> ( i r� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p " \i <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (� m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS U 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o 0 ,C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. l/L) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ' <br /> CONDITIONS OF PERMIT: g, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �11 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> tCk <br /> 5.%J1 m wmo0nn f m <br /> 6. $ 3 aam � ;a <br /> N C q y 0 = 3 <br /> 7. Z N O O 10 <br /> O �t M <br /> m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of myGt c ' C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 : w <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize in o v <br /> CD <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access tot above described premises a asonable time for the purpose of inspection. ° o <br /> m <br /> SIGN HERE �� n <br /> (signature of own uilding contract (date) <br /> ZONING ADMINISTRATOR <br /> EA 0 EA EA O� N <br /> N N N O <br /> (n 0 O U0100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />