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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 /> N O» <br /> N <br /> C <br /> fD <br /> OWNER „ 2 i P ` S r t e o 2 1 e$ C,V al c- TELEPHONE l 5 �- 9 3 y-y 7/ 7 0 0 <br /> MAILING ADDRESS �{ - `r m 2R G (�_ T� S'J „, 22 t/21�' ,rn(0 53)11 O� <br /> 11 1, O <br /> PROPERTYADDRESS SDRia,q ryoleeN AejAij,,g � UNRI&C1ZU,N"e <br /> i <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLIN BUILDING X ARAG6 ACCESSORY STRUCTURE ® ADDITION ❑ Cl) 0 (� <br /> TYPE OF PERMIT(S): r <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> rn <br /> STRUCTURE/ADDITIONQSE: N br..Mr:A&R(i M( (w iV R T l AC li e� ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) co <br /> * <br /> BUILDING CONTRACTOR: i'eS N 145 MMS 1 litl<,%,v? S 16V ` m <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. In <br /> MN c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> T 0 <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 <br /> NORTH(N). to 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDINGS)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 t <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �nl C� <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. f 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA ON MAY BE DONE WHEN ° <br /> NEEDED. �U �� )p � �. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. /' o <br /> CONDITIONS OF PERMIT: � J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS O/FkJ RM T ^j <br /> r� <br /> ISSUANCE. -`meq v I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREI, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY<0ATTED. 11 OU� �J.I <br /> 4. NO SPERTRUCTURES,UCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER I <br /> SETBACK AREA. M <br /> 5. <br /> m 0r- IT > ono <br /> 0 00 <br /> 7. O <br /> O T G <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - c c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of @ ° d, <br /> ID 0M <br /> : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m CD <br /> mo <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <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 . <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fD o <br /> CD 3 v� <br /> (� A <br /> SIGN HERE `ONIJ. t <br /> A A._ - btt/A .c. A4 �- .2 d �2 6� <br /> (signature of owneor bul Ing contractor) (date) a <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED f^ U � <br />