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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 o <br /> r (1 1 <br /> N 0 <br /> N <br /> OWNER <br /> 71 ME S 4 �;iM �/ AWDE(Z5gN TELEPHONE_ 1 l5 - a s cl 7757o � � <br /> MAILING ADDRESS SVS yk91 ov <br /> i12 Sfl, ILC Ot N' E <br /> (-U 6r,4-e mAl �� f <br /> m <br /> / r <br /> PROPERTY ADDRESS 2 D !�O N (7 L-A K 1E R O A D r is N LR 4r <br /> LEGAL DESCRIPTION(see tax receipt) <br /> .$utv �aQ 3SOt) ' ,dd 1 R Vol,r7) � v, <br /> II 14 + • co <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 'S d <br /> TYPE OF PERMIT(S): '" rn o <br /> ❑ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ v" <br /> STRUCTURE/ADDITION USE: ro�Z r g j/,1 K 'S G To Q-Ar be' o <br /> a �3X o <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> iu <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/n X 71 SHEET OF PAPER. ANY INCOMPLETE OR � I J <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M C <br /> O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tv z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n p <br /> m <br /> NORTH(N). mC <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. c <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, CONTR. CTOR, ETC.,THE PLANS Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA O o <br /> NEEDED. 447/THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. n o <br /> CONDITIONS OF PERMIT: <br /> SUR, © / <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � <br /> ISSUANCE. CCN <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE��NI/V�UNTy <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Csp <br /> PERMITTED. 41� c <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m on, g >0 > 0v <br /> 3n(OD 'OX a � T <br /> z w m o ' U° <br /> 9T2 X <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 21 � A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 �, c <br /> � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize VJ�'�. m 2 o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is `D <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 �J m <br /> providing in this appli tion. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to a access to the above described premises at any reasonable time for the purpose of inspection. m : co <br /> T 0 <br /> M <br /> 0 : <br /> m m : <br /> SIGN HERE (� 4 . 1 2,M3 <br /> (signature of ownyr uilding contractor) �CVFI Q : <br /> t/ ( ate) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED .y( OJr <br />