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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER i Y'{ (C i 1 E L \,Al- A N V E-2"0 ^j TELEPHONE r- /Z —�7 L Z - 0 C a � � I <br /> w ` 'AI <br /> MAILINGADDRESS `) Y - 2-( r (� J a rn L W + Vk N S,S t % � O <br /> / f / Ir � <br /> PROPERTYADDRESS L "6u, 4U is U c&d L 6 W( 5-q <br /> o <br /> X07 6 ) C.Swt Vel /s !Sz -/s� 9096 t yo oc <br /> LEGAL DESCRIPTION(see tax receipt) E _ Z $(r C- 3 YU Al0 2 8k RIMI c <br /> DWELLING/BUILDING�9 GARAGE/ACCESSORY STRUCTURE Cl ADDITION ❑ m <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING 1:1 CAMPING <br /> CAMPING UNIT ❑ SUBDIVISION El <br /> ❑ <br /> / a <br /> STRUCTURE/ADDITION USE: ( "�E C /� K r� <br /> y� A (Home/Cabin; Commercial Busin ss;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: i�FtV IC KN&LL Ll 3 3UUd- )U EEC pie I( LjI d <br /> 514WI <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M w O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> TO Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <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 `o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I t <br /> BUILDINGS, ROADS, LAKE, LOT LINES. _L^ <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, BUILDE OR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. �� I' W �?� ,— _ Q �""o <br /> /�I,.� JTJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE ERIFICATION�iI BW ~ EN o <br /> NEEDED. 2 <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. OR 20Q2 0 � <br /> CONDITIONS OF PERMIT: eURNE <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P /N8 UNTy 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONO SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPOP �_ <br /> PERMITTED. L `' I �� 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WIT Li t IRR �y <br /> SETBACK AREA. rrr III <br /> 5. � bt U�CG�� -t U be L�Sed Gra APR 1 2/ r D o D O V <br /> 6.1(l� S 1, N() f �W_f wC 3 _ O Oaf m <br /> ons►ie BURNE 3 n <br /> ,h L1 f Y lCi it r T"► CO = N y J <br /> h�'��' � 7r)NII 'r'UNTI/ N " _ m <br /> o T� � <br /> I declare that this application (including any accompanying schedule) has been examined by Rd and to the best of my C <br /> 1✓ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeM o mo <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 Q ' d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other J <br /> authorized person to hav acce 5 to the ove described premises at any reasonable time for the purpose of inspection. o <br /> CD <br /> N m <br /> SIGN HERE L ^' L� 0,1,j ZI 0 2,(jJ -L <br /> a <br /> ( ignatur owner or building co a ttoor)� (d e) <br /> ZONING ADMINISTRATOR `-% �Y ,/ <br /> N)EA fA fA 0 N <br /> � 11�� , C O O <br /> N (T NNOO <br /> O (l� (T <br /> TOWNSHIP PERMITS MAY BE REQUIRED O {jf�{T�1 <br />