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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v L7 Z <br /> APPLICATION FOR LAND USE PERMITS 3. �J.) <br /> r <br /> m O <br /> N <br /> C <br /> N <br /> OWNER C ?. b— ,v TELEPHONE75?-55-111-7499n <br /> .,uc & a_�rt -a�. . an 0 <br /> m <br /> MAILING ADDRESS 4012 Janet Lane, Proo'clyn Center, "4,T 55,129 0 <br /> r � <br /> PROPERTY ADDRESSSC20-9P 44.9/x0 455/1.20 S20/T40314TF7 'AC?"S 2-40-14-20-0 <br /> 1 <br /> 03?00 Lot 14 CSS.' T' S ? 275 ?.moo^atec in ^Odl Lot, 7 ' <br /> LEGAL DESCRIPTION(see tax receipt) ' m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION (p o <br /> TYPE OF PERMIT(S): Q <br /> FILLIN �G CAMPING UNIT ❑ SUBDIVISION ❑ <br /> < <br /> YU , <br /> STRUCTURE/ADDITIONOSE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) (n <br /> mkA <br /> BUILDING CONTRACTOR: D U m <br /> Cl) <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M r. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OIn <br /> n <br /> r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <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 C7 v <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`' c> <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR Fly p. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACT ;� C.,THE PLANS OV <br /> MUST BE SIGNED AND DATED BY THE OWNER. / /\JJ o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIO MAY B Cr;-,*H�f� o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ? ryry o O <br /> CONDITIONS OF PERMIT: B�pA'� 4CpJ^ V1 a <br /> 1 <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT A'//,t'co <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,V'Ya: ' `" per, I <br /> Uj <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m d <br /> r' >vavv <br /> A') <br /> 6. 3cLm0, <br /> (D C: 3 <br /> 7. Z `n apo . so ={ <br /> o <br /> M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G1 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 vi <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D o : M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> t7 <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ° <br /> m <br /> authorized person to have access toout,above described premises at any reasonable time for the purpose of inspection. o <br /> (D m . <br /> SIGN HERE <br /> n : <br /> 1s1 a of ow o wilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> v+En <br /> (57 <br /> (1 fA di W fA � N <br /> ����� NU1NN00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />