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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> N <br /> C <br /> (D <br /> OWNER �udo ' n <br /> pINOOn?O1A 0/ TLEPHONEO% ` bpq6O <br /> `- <br /> f ty <br /> MAILING ADDRESS Z3 17,0 U41Nh,9m LAKE_ )ed,, S/RHJv. <br /> 0 <br /> 0 <br /> PROPERTYADDRESS 5R MF, <br /> (6,6V 1-67-4 Fiernay Lora) <br /> LEGAL DESCRIPTION(see tax receipt)LoT 1 (fSN6 V I q P 30 (Zsr ! V f P 6S <br /> 1 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION G rn o <br /> TYPE OF PERMIT(S): (i j a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: fla/y7e. OVI7701V DF /VF_'W ROOM 16 & 99 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck,etc.) m l' <br /> BUILDING CONTRACTOR: <br /> I ( ^ <br /> CD v 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) C) a �z <br /> n r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE �l <br /> NORTH(N). fA o <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)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N Q <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. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA-0 A 1( DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J C5V'R <br /> o <br /> CONDITIONS OF PERMIT: I S C��� ` 7(' <br /> UUU � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF ERMIT ?O/ <br /> ISSUANCE. vC/R/VF "C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI (�O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY -. Olv,�C UIilTy, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> y m ani ori � O Da 0 '0 <br /> 6. <br /> o � C <br /> 7. o N TZ <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Qyy �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of V m <» <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m o mo <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 I am <br /> Vv . <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. m o <br /> m m <br /> SIGN HER �� QL <br /> a : <br /> (signature of o r or uilding contractor) (date) <br /> &0 \ <br /> ZONING ADMINISTRATOR C 60 69 <br /> ,/�( r� N Cin N N O O <br /> TOWNSHIP PERMITS MAY BE REQUI D / d <br /> /L r 10 1 �- <br />