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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND Ur PERMITS 3 <br /> OWNER Z,//CR y ^d St 1S1 LV RrlY{[/d!�O, TELEPHONE '5-0753q - 3`fa� n C <br /> O <br /> m <br /> MAILINGADDRE -//0SS �0 CM ST "SW A-.4"All1m:w '0y, -�6t/ m O <br /> PROPERTYADDRESS <br /> e O <br /> LEGAL DESCRIPTION(see tax receipt) Gsg7y s P 33mZ ( j N N(/)NGJ)(Gt/ S//IA// 3yyeo5 <br /> 2 <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ( (A O <br /> TYPE OF PERMIT(S): rO c ' <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION El <br /> STRUCTURE/ADDITION USE: 4C/1,t E: /17/X 5a (MmaA^.CLAnO \o <br /> d` <br /> (Home/Cabin; Commercial Business; Bedroom; eck�et�cj co <br /> r <br /> BUILDING CONTRACTOR: �Tk"A81-6 14011A <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Tnsi D l� /I/1 0p = C n .I) <br /> V L ( li M N ` I <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m .`°. <br /> NORTH(N). y w o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m a <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 Q� <br /> BUILDINGS,ROADS, LAKE,LOT LINES. d 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 -ZMUST BE SIGNED AND DATED BY THE OWNER. ,a o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN T <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> n l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. lll]JJJ1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. <br /> 6. m F3 am xa A <br /> omc � `.' o � 3 <br /> Z C in m o <br /> 7. o m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y ) Y y <br /> O [ C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of g i� m' n u, <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize M 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 /> O : <br /> sue a permit. I further accept all liability which may be a result of the Cou f in on this information I am <br /> providing In this application. I agree to permit county officials charged with d ii e ' o s r other <br /> authorized person to have access to the above described premises at any rea t or p i s ction. ` m <br /> T n : <br /> SIGN HERE - I /O - Z3-(9 <br /> m n <br /> fA n <br /> (signal re of owner or contractor) OC rmeat <br /> 6 Oe) Q i i <br /> ZONING ADMINISTRATOR \ CC "L _BURN <br /> IE I I L;QUNTY�— <br /> v^ <br /> O, IA fA 63 d1�N <br /> O " 0 W w ( O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING o <br /> THI ERMA IT SHALL EXPnRE ONE YEAR�/F.RLO�M (DATE - Ii�S�+°NC�j � <br /> LSI f YfY' C�'f irl K-el 7 V �6G(r J� LYl1�Q.{/ �a <br />