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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrto W j o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> &, O <br /> O <br /> OWNER -f- p TELEPHONE <br /> 111am 2S r -6' `�LSLLn l.�l'1t'IS-�L'y� sev� 6 'JI-73® —fL, ly O <br /> Wt-k e51- a9s—a845 <br /> HOME ADDRESSr O <br /> a3(o7 LJ i, I 1 PS e VP_ . IJ0t3j6urv� [AJ 55185 <br /> be+u)e—o r )-a+ 3 F i re. x'-17-1$ -Ir o <br /> EMERGENCY/FIRE NUMBER Loi rj Firc. 3H76y ROAD NAME SCehtC. V; L' uI <br /> c <br /> LEGAL DESCRIPTION(see tax receipt) Loi- 11/ 5uhr%SN- BeA��) P rLue4, +e- La3c-e tt� +ke —Faui,n of \ m <br /> p-6'� <br /> �' <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION 1:1 PRIVY C�u.n+yy)o� c o <br /> TYPE OF PERMIT(S): Bim. nez++ n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ W= < <br /> N <br /> 1 �\ <br /> STRUCTURE/ADDITION USE: N � ZII iM 1 v,c 1 r�i n . r�ac�c 0 <br /> (Home/Cabin; Comm ial Business; Bedroom; Deck; etc.) (n <br /> v <br /> BUILDING CONTRACTOR: ung r kBu Itlr� Dn i r, Er c�c nr, n <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz m X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). (A 0 <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. 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO a <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRAD OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CQ -� C.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. Ll1 �j o o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF TION MAY ° <br /> NEEDED. F <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. - a <br /> CONDITIONS OF PERMIT: SU <br /> RNE�. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT zpNIN®uN� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. <br /> 4. N STRUCTURES, INjCLLU'DIN`G R/ETAINNIINGG,s_WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. TBACK gREA/1E�VV H <br /> � <br /> 2 O <br /> � 3CO. <br /> 6. nmz <br /> C C N y O j 3 <br /> y O <br /> 7. o . -n m <br /> = y : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (� r A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofJV a 5 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D 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. I further accept all liability which may be a result of the County of Burnett relying on this information lam p <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other (a <br /> P 9 PP 9 P tY 9 9 tY <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. �, <br /> - : <br /> m <br /> (n <br /> SIGN HERE I 0-- 3--O I <br /> (signature ne bu actor) (d te) <br /> ZONING ADMINISTRATOR 6 O <br /> T NSHIP PERMITS MAY BE REQUIRED q <br />