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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> C <br /> OWNER + -S TELEPHONE 7/ C��� E� a <br /> m <br /> MAILINGADDRESS /�Z2 A I f / 0 <br /> or <br /> PROPERTY ADDRESS o I ?.-) <br /> LEGAL DESCRIPTION( n E LL J 0r ke } `D � <br /> YS 4 / , m <br /> RE ❑ ADDITION U) o" <br /> TYPE OF PERMIT(S): j 1 � ,` S c � <br /> STRUCTURE/ADDITIONL o" <br /> ss; Bedroom; Deck; etc.) 0 n� <br /> BUILDING CONTRACTOF o3 <br /> A PLOT PLAN MUST BI m <br /> ER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAN 3 1 g\'t \ y,� \` �� L,/�,; O <br /> DIRECTIONS FOR PLO' } -�V 0 C <br /> 'n a <br /> 1. ALL REQUIRED DII TO SCALE. n o Z <br /> 2. SHOW THE LOCAT �0 <br /> ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). c 0 <br /> 3. SHOW DIMENSION ILL LOT LINES,(B) BUILDING(S)TO CAI 3 CENTERLINE OF R ,nv_UMUMARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 0 <br /> 4. SHOW THE LOCATION OF THE WELL /WI Qcn--' =1ELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROAD. YYC <br /> 5. INDICATE IF A WAL p <br /> {ciY` l �f� <br /> i� I BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLAT ALDER,CONTRACTOR, ETC.,THE PLANS ° <br /> MUST BE SIGNED /_ _ � U/�� y t o <br /> NOTE: BUILDING/STRI =VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. <br /> THIS PERMIT IS SUBJEC' <br /> CONDITIONS OF PERMIT //ir1 P <br /> 1. DRIVEWAY MUST ME � � <br /> 'S OF PERMIT <br /> ISSUANCE. ,t f'/�v� qp <br /> 2. REMOVAL OR CUTTII u n �j� IG SHORELINE. d <br /> 3. NO GRADING OR SH( � I; '�c ��"5jw r :IFICALLY <br /> PERMITTED. r�s <br /> 4. NO STRUCTURES, IN( ,I Par �d -� s fHE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. �11 m com r > paves <br /> CI <br /> � `� m Pr.a o m xam <br /> C , <br /> - <br /> 7. Z C y . p : 7 n <br /> O m Tom : X <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my M <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of ; v � : C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize Cl m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- cn <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 a0i o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time f e O '*y i Pu pp e,^o sp@ction. -n a <br /> m <br /> SIGN HERE ? )JI I I CD <br /> a <br /> (signature of owner or building contractor) _,1 <br /> (date) 0 <br /> ZONING ADMINISTRATOR �J 2004 <br /> .__ fA 6A ffl Hi N <br /> TOWNSHIP PERMITS MAY BE REQUIRED -1UR ET o COUNTY CDLn O Cn Cn Ln O <br /> THIS PERMIT SHALL EXPIRE nNF Y1=AP POMA nere nr ieei i&MINING <br />