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Y1. � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 <br /> APPLICATION FOR LAND USE PERMITS o <br /> 3 <br /> N 0 O^ <br /> p 4 <br /> OWNER eN Y101'� 1 t�' `'1Q,('Q k TELEPHONE / n <br /> HOME ADDRESS <br /> 309'.-'a co n:ty Rd <br /> A <br /> 1i112 <br /> EMERGENCY/FIRE NUMBERROAD NAME Cry lZLl ,¢ <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) Pyr �� Gpvfi (cj <br /> rLG t7 11. 9 767,, Cl) <br /> N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LJ ADDITION PRIVY bHrk <br /> TYPE OF PERMIT(S): I o <br /> FILLING/GRADING 11 CAMPING UNIT ❑ SUBDIVISION ❑ O n <br /> STRUCTURE/ADDITION USE:�( ►ppm <br /> rn <br /> o �— <br /> Home/ abin, Commercial Business; Bedroom;Deck;etc.) Cn <br /> � <br /> BUILDING CONTRACTOR: 260,12,s ° (n <br /> I�/t PYS � <br /> v <br /> Z <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR v <br /> m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 <br /> O O m <br /> -no <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). CD <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF -Z— <br /> LAKE, Z <br /> 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 0 <br /> BUILDINGS,ROADS,LAKE, LOT LINES. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ox`yJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. rz <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �y <br /> ISSUANCE. IIIJJJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m N N n (D d E m <br /> 7. a 0 cy m O 5 3 <br /> Z ymo � ro � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i'u 0C c <br /> all information contained in this application(including any accompanying schedule)and 1 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 /> m 0 <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ° <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mD <br /> : <br /> m <br /> SIGN HERE D <br /> //� (Signature of owner or b []dingcontractor "moi"— <br /> ) (date) <br /> Y \: <br /> ZONING ADMINISTRATOR �(YZ <br /> O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />