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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of zoning Administrator 'n0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> l ^ Nn O C, <br /> OWNEli � mj 1eK MA�+,� e�nSK� TELEPHONE,6/2-634` 206 ¢ t� <br /> 1 <br /> Cl,7/,vl <br /> MAILING ADDRESS 7q �j kb� � n! � �� <br /> f <br /> 1#120 ���I42 e ' <br /> �^ <br /> PROPERTY ADDRESS C'-f^ S iM 1 /' ^7 � � i I/ ������� � � J4 <br /> Gov, �r,� /i S�Ltic l9 fvw� , A 'I, <br /> LEGAL DESCRIPTION(see tax receipt) , 1 S� P '-� � /�/CJ <br /> tL(,/��-1-n t��r�� Su)1 S� !�1 r r 6t• � rn <br /> m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 <br /> TYPE OF PERMIT(S): CC LAlIL�f wt c <br /> FILLING/GRADING X CAMPING UNIT ❑ SUBDIVISION ❑ <br /> a <br /> STRUCTURE/ADDITION USE: C4��7 N <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR:0 (JQ - m <br /> M I D w H//U c.-<Le y rf9n3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> - <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING_ (AERIAL OR TOP VIEW) <br /> O m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m \ A <br /> NORTH(N). <br /> CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO T \ 3 <br /> G <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 Z <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. O C) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE N 9J <br /> MUST BE SIGNED AND DATED BY THE OWNER. PLANS 0 <br /> o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ' ^ , <br /> NEEDED. o Y� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o v' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1- <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. J Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER d <br /> SETBACK AREA. <br /> 5. EroSip6 OW --SPI P16- n 5t,�-bm�4++e-d+o pprovtd frx uDC -fo bR- a e md, fio'n <br /> /n� �n7 CD OoOrDpDO � <br /> 7. I� 0� l_-l. s3 a � Fam M <br /> Z 0= <br /> m C M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o m� . es O <br /> — cn : m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m cn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m J <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m o l7 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other M C <br /> authorized person to have access to the above described premises at any reason J CD <br /> m <br /> �--� on. r <br /> SIGN HERE -ftj 0 D <br /> a <br /> ( tur of o or bw mg co act ) (date), o <br /> ZONING ADMINISTRATOR 1 on L L p <br /> TOWNSHIP PERMITS MAY BE REQUIREOURNETT COUNTY <br /> ck�d u� THIS PERMITS ALL EXPIRE ONE YEAR FROM TE OF ISSab�NG <br /> ►- w �, [e t�epi �v�-rh zs� r- <br />