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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator 'D O Z <br /> APPLICATION FOR LAND US PE <br /> IT <br /> � ° <br /> �Ylir iG� <br /> - 7 loss 'S7� <br /> OWNER �uGfNE mRR�L4 60�sow 5 TELEPHONE 3.�q �jq/ n <br /> v W <br /> n- • _ m_ <br /> MAILING ADDRESS }of E: ;D r70 <br /> PROPERTY ADDRESS � Sv1M <br /> ro"C Aj"C '`J <br /> 4tD � <br /> LEGAL DESCRIPTION(see tax receipt) O�C 3 W P Q I(p PCI:GO (v 1 Z <br /> (O� � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ElADDITION 1� <br /> FILLING/GRADING El CAMPING UNIT ❑ ElSUBDIVISION <br /> STRUCTURE/ADDITION USE: d N N p-00 f"- i)&j bec(L <br /> (HomeeLCabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: >1 4+SI f�f ii+5�j(C)F j <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF P PER. NY IN OMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. .�} J O 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 CD <br /> i-- C•1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <br /> � o ? of <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C ct <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m z_ <br /> CENTERLINE OF ROAD,(C)BUILDINGW <br /> S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHM)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 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. r <br /> c F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o (JJ <br /> NEEDED. (vim' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o r ry <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 0 <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 0m> oavv <br /> m 3 a m � a m <br /> 7. m Co ° G <br /> Z R m O <br /> O T'< : : M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of m N Q <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a' in S <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize a o m <br /> that this information I am providing will be relied upon by the County of ns'n to determinin whether to Is- <br /> sue i permit. I further accept all liability which may be a result of the infprmation I am i m <br /> providing in this application. I agree to permit county officials char t n n cea or other 'm <br /> authorized person ve acce r' remises a reaso or a e, f inspection. ' m <br /> m <br /> SIGN HERE m E m E <br /> gn ture j <br /> o ow or building contractor) date) a E <br /> ZONING ADMINISTRATOR / BURNETT <br /> COUNIY <br /> ZONING 4 fA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o`� <br /> TH PERMIT SHALL EXPIRE ONE YEAR F OM DATE OF ISSUANCE <br /> Ct>= <br /> Ie4 Up ��� le�4- r by �c$Dlc> SKi S/��J <br />