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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v OZ <br /> APPLICATION FOR LAND USE PERMITS 3, <br /> r <br /> OWNER Q� m�} �J(J TELEPHONE 30 3— 74Z 9, o <br /> HOME ADDRESS / � <br /> �Z�f3 S lle4,CEAR QAY 6ti/64,6_ W000 o ?6tl- <br /> 0 m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME �iD�N �/ <br /> LEGAL DESCRIPTION(see tax receipt) L 3yy-, S 3y{ - Cn <br /> 1 <br /> m <br /> DWELLING/BUILDING 21 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY [:] y <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> 5. <br /> C�BI�tI y x �a y <br /> STRUCTURE/ADDITION USE: 3 0 ,� <br /> // p (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> BUILDING CONTRACTOR: 4K /1 U/S Fj �JlLD iV� `r l✓ �_6N 1&2 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/2 X 17 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a ` (� <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ? r <br /> NORTH(N). C T ckj <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) pp V B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFIC� Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. VAI 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 <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 c <br /> O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENa 0 <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. � SSUe <br /> X v W W peL 't7 <br /> m m m m <br /> a m C vNi N O j <br /> 7. Z N N <br /> O <br /> Cl) <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 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- O <br /> sue a permit. I further accept all liability which It of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit I a i Bring county ordinances or other ? m <br /> authorized person to have access to the above d c s e for the purpose of inspection. .� <br /> ri M : A� y <br /> SIGN HERE <br /> fl <br /> l <br /> (signatur owne o i Ing co or(' (date) <br /> ZONING ADMINISTRATOR !/l.� G' i. <br /> NTYV ����En <br /> N (! NNOI <br /> 77��N�('�^�I���+. N O (Ji Ul O <br /> TOW SHIP PERMITSIVIAYBE-REQUIRED _ n : 0 0 0 0 <br /> -3.0 <br />