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Burnett County 7410 Co. Rd. K, No. 102,Siren, WI 54872 Office of Zoning Administrator v0Z <br /> APPtLICATION FOR LAND USE PERMITS 3 <br /> y0 ^1s <br /> N <br /> OWNERelIre 91 ri. �Q TELEPHONE <br /> ` ] <br /> CDO OeJ <br /> MAILING ADDRESS � h� LQr� 2 �l�O��y�,euJ . Int ) 6-s-/ac (� <br /> i 4 r m <br /> PROPERTYADDRESS Gf� SU.('�S D�4.19 _SGOT''( >ow'I`tlIk p 5-i Sol o <br /> LEGAL DESCRIPTION(see tax receipt) PUSel.. l0 j wQ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I!J ADDITION ❑ (n <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> N <br /> STRUCTURE/ADDITION USE: GR S i T'> G AlLt;©O 0 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) rn <br /> s <br /> BUILDING CONTRACTOR: CNN- -3PPtS v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/!X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 pO <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n b <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 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 Z <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. N J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, �� OR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> �. <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER1CATION <br /> NEEDED. / �// � d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. V `SEP 1 8 0 <br /> CONDITIONS OF PERMIT: Q1JR 200? f`r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER'lZr CQU <br /> ISSUANCE. 0nl/N N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G ^ <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 /> /' p — CJ pZ —o-k— / SS a m Wr o a n � m <br /> 6. mB 'aCOD yam <br /> (gyp <br /> 7. Z y m 0 ° <br /> O T"� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ' �j^ O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of @ n v C <br /> W <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C 0 : m <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to In e access to the abrTgescribed premises at any reasonable time for the purpose of inspection. D o <br /> / CD <br /> m m <br /> SIGN HERE <br /> CL : <br /> (signature of own g cTtractor) (date) <br /> ZONING ADMIN RATOR <br /> fA EA EA fA � N <br /> o (Nli O CNn (NT O O <br /> TOWNSHIP PERMITS MAY BE REQUIREDd Q <br /> 13g�0-,49- a4 <br />