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Burnett County 7410 Co. Rd. K, No.102, Siren,WI 54872 OQf ���ggA�o;�,f,��.�.�Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PE �117111'T�'TERjs 3. <br /> _ Co <br /> CD <br /> OWNER L/�LtI 1j J�C7 TELEPHONE a05l-63Z Z,.-zs o <br /> 1 A/ � r CD a_ SV <br /> MAILING ADDRESS �(/ /r k d ��� O y M Al 5-5-//2- f <br /> 2°fltt /Z Sf � e � ft o <br /> / �.0 <br /> PROPERTY ADDRESS a C t A e ��. -51741 G A2C'►", <br /> \, <br /> L o fs 25, Z6� J- Z7 1 L3 lock 3 <br /> LEGAL DESCRIPTION(see tax receipt) a�ke- mC lce�lz-f e ,(3L P c-h 51"6 Cf%✓r 19%y� ' CD <br /> d <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE El ADDITION ® fn�0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONOSE: 6v6tJ � <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) w <br /> BUILDING CONTRACTOR: i 1 R �n'7 5 4-u G 'C'xl v <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p - <br /> X1 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 CD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn o <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO c}, <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IV <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. 3R a F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT y, <br /> ISSUANCE. <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.5. / /- �v <br /> v CD W n CD C. f m <br /> 6. CD BamOx <br /> m C y �' o <br /> o <br /> 7. <br /> ° -n m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - - 0 <br /> PP ( 9 Y ) Y Y �C ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is <br /> (n vl: S7: <br /> sue a permit. I further accept all liability which may be a result of the County of Bu�rpe. rel�rin9r�th)s information I am c1 <br /> providing in this application. I agree to permit county officials charged,vpitlh �Itfst�iin rlt ordinances or other (� <br /> "f : CD v� E <br /> authorized person to have access to the above described premises at y� n Idsoiep' 'se of inspection. o , <br /> [ CDE m E <br /> CD U <br /> SIGN HERE g ✓ �� d 7 <br /> CL <br /> (signature of owner orb ' ng contractor) APR 8 MWaie) <br /> ZONING ADMINISTRATOR / . . . <br /> 'A u BUR /�5.5-4 ��""�N <br /> �n�'�� N (A " " O O <br /> TOWNSHIP PERMITS MAY BE REQUIR� cr C' cn cn 0 . <br /> �Im l&Z THIS P RMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE. <br /> ) �, �7 _ / <br />