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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. IC <br /> r <br /> 5 COW TRo`j v1 <br /> OWNER 79E-UT/Mikr= LAZc TELEPHONE COSI-�IS�—�$'42 Ouo <br /> MAILINGADDRESS 2395 11�1$�—f?L —Dvwe iW0W6UQ%M" SSI O <br /> r <br /> o <br /> PROPERTY ADDRESS I <br /> -raw <br /> LEGAL DESCRIPTION(see tax receipt) 4Cj7— 4rQT S Qs4N6E �7 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (n <br /> TYPE OF PERMIT(S): r �l <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �` 1 <br /> N n d <br /> STRUCTURE/ADDITION USE: BV^)KNOJSt �&A0hf6t �C <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> BUILDING CONTRACTOR: :BLAZEK Ro7W&W 5 l.o"yro cridn! 7Z C. <br /> 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 fr <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> y 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. I N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. t �'o f t <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 o <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o (� <br /> CONDITIONS OF PERMIT: 1Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. (/) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. x3 nm xn � A <br /> o m c; o 3 <br /> Z c m o <br /> �. o o : Tom : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ - i A <br /> PP ( 9 Y ) Y Y E L7 - I -4 : c <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of J: v �_ <br /> PP (including Yaccompanying ) g <br /> all information contained in this application Includin an schedule and I further declare that I recognize C c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn <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 o <br /> providing in this application. I agree to permit county officials charged with athen CD <br /> authorized person to have access to the above described premises at any reas i for r s on. T n <br /> Lm QE <br /> SIGN HERE a q <br /> 0 <br /> (signature of ow r or building contractor) i I e3 e(fl?jp) <br /> ZONING ADMINISTRATOR m - 0 n Q G J <br /> BURNETTCOUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Dern � 4-lei r)P«W t-.(-p y7;1-&,+ glaze <br />