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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER �6RTlalJ/? I1A1\l RQC(ZIQCtaAlfll Ill�t, INIC TELEPHONE 634^ te';{,� <br /> m r' <br /> HOME ADDRESS 1063(a y(%46dAkjv , (ZM/LT RA4ti1A?A F WL S4Ru3 v <br /> m <br /> fytt/J(J\� MCKE/ULIk � <br /> EMERGENCY/FIRE NUMBER ROAD NAME LItKC ROAfJ <br /> SCC 2S A 24 -TWIJ 40 N RAA 6E 14 W <br /> LEGAL DESCRIPTION(see tax receipt) LOT I LAK2 /11c1CQA3fa@ 6eAC1i SUArJlWtStD.Q � <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ V) <br /> TYPE OF PERMIT(S): <br /> CL <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < : <br /> 5. <br /> STRUCTURE/ADDITION USE: C AalN �0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) rn <br /> m <br /> BUILDINGCONTRACTOR: NOA i—XLAAla RCLiZA_ArLjMAl 1Andatt1 ls1c. iv <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/]X 11 SHEET OF PAPER. A O LET R <br /> In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Jp5in � O <br /> � y C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ` 5 ov �� 0 c Z <br /> V <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (] 1'30 a m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ° V- <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. , o o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT I E Er ° <br /> NEEDED. <br /> U " <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1\a' 2 `� 2002 0 <br /> CONDITIONS OF PERMISU <br /> T: ] �• <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE IiiNETT COUNTY <br /> ISSUANCE. GNING <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 /> A -u0r.- v <br /> m <br /> 6. m3nm0xnc,_ ;o <br /> mCm �' o53 <br /> 7 <br /> 7. O : N �j� <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my j t7 c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of xJ nit c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M . <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. 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 officials charged with administering county ordinances or other m <br /> authorized person to ave acc ss to the above described premises at any reasonable time for the purpose of inspection. T <br /> (D : <br /> Q : <br /> En <br /> SIGN HERE <br /> (si ure of owne r uilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> to to v+fn w Fn <br /> N Nut NNP <br /> Vt NO VINO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 00000 <br /> Q <br /> �V it/ O 000000 r1l <br /> —�5X_Lh � " <br />