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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 <br /> N <br /> OWNER 90j h e v T 0 Lso V1 TELEPHONE�� 5) Z (.��-3�SS7 0 <br /> d � <br /> L <br /> MAILINGADDRESS 212- I s` A VQ r ( ea(r- La (. <br /> //e . Liz S qoo s <br /> �� (n m <br /> PROPERTY ADDRESS X k Y X picri pert e j V l <br /> Sa=O)T"40 til R� b W 7D off© `i +q0 02 LEGAL <br /> LEGAL DESCRIPTION(see tax receipt) U)Lit 1 CSM V i`7 PZZ(e of g <br /> DWELLING/BUILDING LJ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ /,, (n 0 <br /> TYPE OF PERMIT(S): W Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ C1 <br /> / b Dox 3 u'llax and �a 5. <br /> STRUCTURE/ADDITIONUSE: Nome 6L ih ° (w1 (� <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) w ^ <br /> BUILDING CONTRACTOR: K.J t. l cn/t5J r Ls d t o ut 'LL C _ 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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> �1Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C �° n <br /> NORTH(N). <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 <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 C�N <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, C6NZRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> JCA o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER ICA <br /> NEEDED. 0 Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. MAY 1 t o <br /> CONDITIONS OF PERMIT: V <br /> �'W2 � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFBPERN G'OU71 r <br /> ISSUANCE. FOND N7)• \ 9 9L <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NC (` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY IRJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING Fj TAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. T ACK EA. <br /> m 0050Oaf m <br /> 6. 3 'nm xa � <br /> lD C N O <br /> 7. Z N O <br /> O T� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of — d m v ,C <br /> C' ^ : 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 u. <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. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized personlla44aveaccess to the above d premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> CD m <br /> SIGN HERE <br /> n : <br /> (signature of Ing contractor) � (date) <br /> ZONING ADMINISTRATOR <br /> EA EA fA fR� N <br /> N (TNN OO <br /> NO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />