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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS _ <br /> r- <br /> N 0 <br /> r! C <br /> CD <br /> OWNER CK O ✓AlkuE V I2�jv TELEPHONE 7/s /9(,-S�(�J `v <br /> Q O <br /> MAILINGADDRESS 0 80A <br /> PROPERTYADDRESS 4�"360/S zolye- <br /> Svc. r CS/"1 3 (, SCj ; rcc.9c�c � yE�cvc✓ � <br /> LEGAL DESCRIPTION(see tax receipt) frSS, �� LOQ 07(0 (3000'tc r'� rn <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ � `'�11o' <br /> TYPE OF PERMIT(S): cC ?) " <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ / �a <br /> STRUCTURE/ADDITIONUSE: �CJ/h A`AL3/nl /9L,S0 ,on/e ee A*Ve �i/9AAGt^ 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: JJf/�+/V f AiR I!K Cit/Z`tX CSL S /�✓G /GaA/ysil!/ /7!J/17t/ <br /> d <br /> 10-e <br /> CDv <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. -n <br /> O Q <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> z-_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 <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. \ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, Cot TRAQT E PLANS Q 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE XWRIFICAUTION /MAY B ff�� FEN g � ' <br /> NEEDED. <br /> 4A� C 2002 Y•vCJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �LJJp pry' Z <br /> CONDITIONS OF PERMIT: PP, !'YET' COUNTY o O C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERtNTNG RJ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 6\ <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. IUew lS. \ Per-d i h 1cy�_ <br /> �6ml oke JYo 7� uyJ A 3�- D 0 D O M <br /> 6. tiJlsi01/ C�i. m c O of m <br /> CD 0 <br /> T m <br /> I declare that this application (in luding any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0 n d, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C, o M: m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m i <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 m <br /> T oCD : <br /> SIGN HERE ` <br /> 3-19-az <br /> a : <br /> sign lure of ow r r building contractor) (date) �i <br /> ZONING ADMINISTRATOR <br /> EA fA fA fA�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED NV <br />