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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> CD APPLICATION FOR LAND U E PERM S <br /> o� C�a 6�.�/ //o�J �SO,.-/ _ r <br /> W O <br /> N <br /> OWNER / L � /'� TELEPHONE `-7/f_ Ayl& ff� <br /> \' �I <br /> HOME ADDRESS //11 �r41 4 P 0 12 / <br /> 0 <br /> EMERGENCY/FIRE NUMBER �xL ROAD NAME �Q/f E+ 041,014) I o C <br /> GC21 CcT �,Y CLsm � 'F' <br /> LEGAL DESCRIPTION (see tax receipt) CSM lI / 7.3 96 � �rr) s 6 /s c <br /> r �m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cl) 0 <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CS. <br /> Sa <br /> _s( <br /> STRUCTURE/ADDITION USE: P�� S/ ff' Ln. <br /> I,x'V' <br /> o ^ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ur 1 <br /> BUILDING CONTRACTOR: <br /> Er1 <br /> -a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> In n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <br /> NORTH(N). <br /> 0 <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. �XJ <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, 9VTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE1 E D EN0 (� <br /> NEEDED. �/5/ 1 0 filly, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1I Z <br /> CONDITIONS OF PERMIT: ����//�������N�3 o ( ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERIWN U r" <br /> ISSUANCE. 21IN CojtVrY 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI 'Y fl ` ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1(\ ��l <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 'M -00 vv <br /> � <br /> • d m n m <br /> 6. m �3CLQ .'e <br /> 9 m C S O 0 3 <br /> 7. Z ` CWD <br /> o A <br /> ly : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G5 c O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am f\esponsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �m . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 COCD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> CD <br /> /` fa <br /> SIGN HERE <br /> siI t of wnerar tor) (date) I / <br /> ZONING ADMINISTRATOR �/ a4l <br /> `J wfn<nFnFnw� <br /> N N Vt N N 01 (T <br /> ut (n O Vt Cn O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />