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Burnett Cbunty 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -0 ci Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> F <br /> n,, ^ C <br /> OWNER •W`l4L rn0#'C' ¢/ / n <br /> I TELEPHONE 7 K- (J t�rj �{? 'E' <br /> w. <br /> MAILING ADDRESS (0Q ?D 1 LS (,,+V—F, 12 a. 1k)'r- >k-C W 5W? <br /> CD <br /> r � CD <br /> ` <br /> PROPERTY ADDRESS JI._CJo 9r34Jl L <br /> a o Z-c37-Z. Ex f /(3 ,- <br /> LEGAL DESCRIPTION(see tax receipt) e Z� fW� qO (Z/(P (tj £ 6-'-A A) Z r 1 C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑• ADDITION r/i 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> I�7DJSTRUCTURE/ADDITIONUSE: DW <br /> 0 <br /> (Home/Cabin; <br /> Commercial Busine;as; Bedroom; Deck;etc.) (n V) <br /> BUILDING CONTRACTOR: rP STlzc,�— Ci+>� � !%?!a _ UI R:e a W <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. /uSd <� /i p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) D`� [/v / j [ i �V/ O n <br /> M O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 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 Q <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADEDqjR FILLED. NCJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CO ETC4.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFjI TION M o U <br /> NEEDED. }� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �pR,p 9 ,oZ <br /> CONDITIONS OF PERMIT: 81JR/v � O <br /> 1. DRIVEWAY <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITION (j, J w <br /> / Y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. I G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m 0 9 2 C a F M <br /> 6. m 3 a m n '" ]7 <br /> 7. Z y o <br /> P : "� : m <br /> declare that this application (including an accompanyingschedule has been examined b me and to the best of m ' : 0 <br /> PP ( 9 Y ) Y Y (J` L7 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c, 0 C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m I <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m � ;f <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 <br /> authorized person toWe access e a ve depc premises at any reasonable time for the purpose of inspection. :CD o <br /> 2 (D m <br /> SIGN HERE <br /> �Nreof or building contractor) (date) pp ,� n <br /> ZONING ADMINISTRATO (N <br /> m fA fA N <br /> �2 C� Jr N(J1 O <br /> N ro N <br /> VY�( U TOWNSHIP PERMITS MAY BE REQUIRED L" 0 CA Ln 0 <br /> EVSSt1'-m THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />