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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> m O <br /> CD <br /> OWNER .L/�Il�fi /i"3 ` _, J, Me /\ TELEPHONE �s� -63 3 _O(DO e <br /> HOME ADDRESS % 3 — /1 r4 ifve Ste• /uPw �-?L j4i7o v 4 ty > <br /> CD <br /> / /y� ,/ r ep <br /> EMERGENCY/FIRE NUMBER � ( �, /'/d d/ Pcr✓ 40 j ROAD NAME O <br /> 1 <br /> 517 /i 38'l of 170/ 38-/7-�7 - V <br /> LEGAL DESCRIPTION (see tax receipt) �G L �nV /19. 'L{Cr S4oreI CID <br /> — <br /> O. T <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNITS <br /> SUB IVISION ❑ < <br /> �,/.� <br /> STRUCTURE/ADDITION USE: 'Y�� /16A ,41 <br /> (Home/Cabin; Commercial Business; Bedroom, Deck;etc.) m <br /> 2. <br /> BUILDING CONTRACTOR: �i /►1 1 GtOer m <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. p W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT o VCJ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). lCA 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. ° <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. G <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 Cy- <br /> N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. c'° f <br /> o 0 30 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DtTQUIRE�D <br /> ISSUANCE.2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED AL3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPPERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIWA <br /> SETBACK AREA. •a� , / 9 <br /> 5. C/� V � � V jCQ ( W Or- > 0 <br /> CDnF m <br /> 6. 2 Liv a--_ ANF Oj ` ' n y a 3 <br /> J � N; <br /> 7. �� _ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to�est of my 0 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of fl. <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. 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 <br /> authorized person to h e access to the above described premises at any reasonable time for the purpose of inspection. T m <br /> m : <br /> SIGN HERE <br /> (signature of o r or building contr_ac-tor/ ,^ (date) fI 1 <br /> ZONING ADMINISTRATOR <br /> /Yl Zt <br /> �) <br /> TOWNSHIP PERMITS MAY BE REQUIRED � � Q <br />