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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 64872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> r U <br /> y O <br /> N <br /> OWNER P,JO CewdirctJ Lori LLC _ TELEPHONE (-715�2�;3-30�s� _n <br /> 1 W d' <br /> MAILING ADDRESS Ault (A) C l ca r Liter (A)1 5 400 S M O <br /> I <br /> PROPERTY ADDRESS X X X X S1 n N e G aA IL <br /> L of (o CSM Map t#pZ'70 V 3 2O$ �� .1 <br /> LEGAL DESCRIPTION(see tax receipt) C�ov LOt 2 C T`fU u � -1-0204133-02> 0C) �E <br /> N 0 <br /> DWELLING/BUILDING L✓J GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONVVI <br /> ❑ a <br /> STRUCTURE/ADDITION USE: 6 C-20LoO� Do-ek - 40 o w <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> v <br /> BUILDING CONTRACTOR: S P <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> -n a0 v <br /> TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y A o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 w <br /> BUILDINGS, ROADS, LAKE, LOT LINES. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED ILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER' C 9 JC.,, HE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. JNOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF ATION MAY H o <br /> NEEDED. t w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �7 v 00 o V4 <br /> CONDITIONS OF PERMIT: &VR/�/E `" � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT`'®COV�y ( uJ <br /> ISSUANCE. NG <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. h <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY '`vQ <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5 BACK AREA. k &�erY <br /> /l�/ G <br /> 1 �L/ M orDOD017 <br /> M m � omc" M <br /> 6. D me (DXo �' 3 <br /> V N N <br /> 7. Z y M ° <br /> I-Q <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — N ' A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of G� d da C <br /> PP (including Yaccompanying ) g <br /> all information contained in this application mcludin an schedule and I further declare that I recognize m 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 /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am : a) <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person access to the ab escribed premises at any reasonable time for the purpose of inspection. T m s <br /> mo <br /> P1 � m : <br /> SIGN HERE — 5-03 `^ <br /> (signre or building contractor (date) n <br /> ZONING ADMINISTRATOR ` e G <br /> /VV (TO (n(TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />