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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r C) <br /> w o 7.J <br /> 7/5-433�5--`16503 <br /> OWNEREj41,5trcC 5/,r,,iko TELEPHONE <br /> C>3 <br /> a J <br /> MAILING ADDRESS Z(Y/T— `,Z '�I 57 A U) Ale J ���t�T� NAJ F <br /> r m <br /> 0 <br /> PROPERTYADDRESS l3 5t�a <br /> 9 C Nc T d/ /t/e W1 5h?o ! ( n <br /> Lofs , <br /> LEGAL DESCRIPTION(see tax receipt) L5, z-4 �-Z761o,k- 3 �,,ke <br /> L <br /> udaj). /Si to cr (p,' <br /> W <br /> TYPE OFPERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE ® ADDITION ❑ co <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: S�<�ra y e �cR. ��/• /o X 147 y <br /> o' <br /> C (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) co on <br /> BUILDING CONTRACTOR: <br /> m <br /> v lAv,' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Om <br /> /Zl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE (O <br /> m <br /> NORTH(N). C 3n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)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. pv \ 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 /> 5. 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 0N <br /> MUST BE SIGNED AND DATED BY THE OWNER. t� -f <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ON VE12; <br /> O <br /> NEEDED. �J <br /> � 1 ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. jA,/n Z d <br /> CONDITIONS OF PERMIT: Vo "� o <br /> 571Ms <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS O ` J v <br /> ISSUANCE. 7 rr COUN qq <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL1fi�DN/NG TY lJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 'I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. �j�� &&c( -i%'r7"U &T 1/ or Read5. 6ujner' 1�(ICCt d 2/ ' ' `"• 1 5�111GY <br /> 1L �//O se/4aCIC �n60IL b-e- t� = C nrD0Dt7 <br /> 6. «hf Cl t 1.�ctl�- m d L E m <br /> d _ (� m 3 x3 � � <br /> 7.3 �, 7—o 6-e r-)o )tAlig' Q-t-m, in dSl,Q / s t&refy �/� OW y y y a K <br /> Z n M0 o . <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C d, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- tD <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other w <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> _n o : <br /> SIGN HERE <br /> (signature of owne ilding contractora <br /> (date) <br /> ZONING ADMINISTRATORGl`Il <br /> fA fA da 6A�N <br /> N U t N N O O <br /> PO (T (POO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> A A6 a 5 al--9a_ <br />