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- ON C pp�� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of ZoningOA�dmin st1'a� Nip o 0 <br /> APPLICATION FOR LAND USE PERM S 3. <br /> N <br /> OWNER �Cl e �a{'"��-� . �J�-.Y�j"1 TELEPHONE (p,�� n C' <br /> o <br /> r_ m <br /> HOME ADDRESS �(I YL( n SSI S <br /> EMERGENCY/FIRE NUMBER �� ROAD NAME �00n Lane <br /> L(Tr a In��l fa I 2 � S \' <br /> Govem,�,e.,I ) o� '{ ons 4 To nshr' rah, C/, <br /> LEGAL DESCRIPTION(see tax receipt) I r1in <br /> PC1 m <br /> nn ' 33 -gyp y���p <br /> DWELLING/BUILDING kYGARAGE/ACCESSORY STRUCTU ❑ DDI ON ❑ PRIVY I`„ `S Cl) <br /> TYPE OF PERMIT(S): Sln .U� r!� rr <br /> FILLING/GRADING ❑ CAMPING ❑ SiJ IVISION ❑ .V� S. <br /> Q_`J iX, /J� m <br /> STRUCTURE/ADDITION USE: .n �X n r <br /> (Ho /Cabi `Commercial Business; Bedroom; Deck;etc.) /Ov Cn <br /> C <br /> BUILDING CONTRACTOR: t1 <br /> v . w) <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c <br /> n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m c <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ..30 <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C> <br /> BUILDINGS,ROADS,LAKE,LOT LINES. ) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED,dR F)Lt <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONT►¢-`=� CNS ( I <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE Vg�IFICAT�r��i ftM Y.?E DONE WH Nj q S <br /> NEEDED. tt11YY 2002THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ! BURNETT COUNTY <br /> CONDITIONS OF PERMIT: ZONING O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � I <br /> ISSUANCE. 7� S� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> c!) o <br /> PERMITTED. IN <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Y�M �v efl Peri- �S <br /> 5. oNSiokt G�c ►`l� F)d Raw yo--jfi IM M.L m <br /> 6. l/n ti /alr�ir� s�[� /i�S�J �� : y m o 0 0 0 3 <br /> b SIN VS <br /> 7. �►� IBJ A 1 f6 �T3 � e Z <br /> Ot <r 6 Y U G '- � E m <br /> I declare that this application (including any accompanying schedule) has been examined by me an a best of my O c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the det curacy of c 0 <br /> all information contained in this application(including any accompanying schedule)and I further decl re that I recognizem m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I amt <br /> Q <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the p rpose of inspection. T <br /> m <br /> Z <br /> SIGN HERE <br /> a r r ildin contractor) (date) <br /> ZONING ADMINISTRATOR <br /> to w 40 ultototoLh <br /> N N(T N N N N <br /> 0 0C)0 0 0 0 <br /> TOWNSHIP PERMITS M E REQUIRED <br />