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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3. ° <br /> MAC <br /> n ° o <br /> OWNER ��1 1 i-)f l�n C L�h 1v TELEPHONE 7/S 65-6-3L 46 a it ^` <br /> MAILING ADDRESS P,()_ &O X 247 <br /> ` ,/f►Al Q CL Z Wt 5 4 ry�y M j <br /> (�' ',1 b � M�� <br /> PROPERTYADDRESS low� C+v Rp , t- > NI �G{ 5-4 k3o � I <br /> 3a 19 41 -17� s-a o� 31 FRT N BI -S� w-- <br /> LEGAL <br /> � <br /> LEGAL DESCRIPTION(see tax receipt) S 3�IT�//�R Ibry />'CRe-5 �1 •7a� $ LYCT W d F Y'e( <br /> OD lI r Cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREADDITION ❑ c a <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ Cr <br /> S. <br /> STRUCTURE/ADDITION USE: I7rff�7 C( /7�DL /�\(/3 L� / `� p o Uj <br /> (J(Home/Cabin, ommercial Business;Bedroom;Deck;etc.) (n , <br /> BUILDING CONTRACTOR: MIKE 6210RM141`] ^ D4N Q(AikY <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 4- <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �t - <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � <br /> 71 n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> Z <br /> A o, <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(8)BUILDING(S)TO m v <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. Z <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. O <br /> 5. 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, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o U)I <br /> NEEDED. I, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ��IXXXJJJ <br /> CONDITIONS OF PERMIT: <br /> 4 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m0 CD CL <br /> 6. 3 nm 0, EL <br /> 7 N C y y O j _3 <br /> Z m C ' -0 i <br /> T� x <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ;, C : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CL m E o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 offs ials charged with administering county ordinances or other <br /> authorized person to havji access to he abovej describe emises at any reasonable time for the purpose of inspection. . <br /> CD CD <br /> SIGN HERE <br /> (si ure of or building contractor) (date) <br /> ZONING ADMINISTRATOR Q'/t <br /> 1--I1 <br /> `0-7 r l n fR fA fA d1.+ N <br /> (•+/iC/O.SG, N (TON N O OO O <br /> TUT <br /> TOWNSHIP PERMITS MAY BE REQUIRED C ��� i�GG- <br />