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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 ci Z <br /> r - APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 7 c o <br /> OWNER �U�'�LZICX CJ /�LL�"1 z� TELEPHONE <br /> MAILINGADDRESS 300L4TV15 i vu,� `/� ^/5 „rn� <br /> �lQ/l t't' G J `t <br /> PROPERTYADDRESS av ct3l 6dyUa'ru daige Tt2���r�Gl�f <br /> S. ai T. 3769.1 f <br /> LEGAL DESCRIPTION(see tax receipt) k$'l <br /> J.c i- i y Cs fy V7 POLI n Gov. Lot a <br /> cmn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): y 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB/DIVISION ❑ FL <br /> STRUCTURE/ADDITION USE: rn <br /> (Home/Cabin,Commercial Business;Bedroom; Deck;etc.) ' rn ' <br /> W <br /> BUILDING CONTRACTOR: Ll <br /> Ln 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR �' r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) H <br /> c -\ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r <br /> CL <br /> V <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 0 A <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO INTI � <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES TO P <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF <br /> O ' n <br /> NEEDED. Nr -Z) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. C <br /> CONDITIONS OF PERMIT: e��p�JUN 6 C 4 OP � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OA"S S <br /> ISSUANCE. 7T cot jN UJ <br /> INE"NNV(z` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI t' p� <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. r /L _rf <br /> 6. �� 1 `J m 0 0)i 0 m a O � <br /> �. Y1 ✓ ;b7JYzC_ �1Q <br /> 3am0g C <br /> mcN !' og3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my T p <br /> v,: m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 in S <br /> = <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ? m I o m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 m <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 <br /> q . M m = : <br /> 0: <br /> m 0 : <br /> SIGN HERE U,l� �,J / _/{� � <br /> (signature of owner [ding contractor) . _ I (date) <br /> ZONING ADMINISTRATOR <br /> 1 : E <br /> fAfA 69'A N <br /> NO NNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED N O � Cn O O <br /> 6falx," �J <br />