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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS <br /> T 0 <br /> CD <br /> OWNER \ N <br /> L�aM I J IL NE 5-r(?A N o TELEPHONE <br /> MAILINGADDRESS <br /> -1-9 t AVE N ►'V NEW W TQNr /III 1� DSII Z <br /> PROPERTYADDRESS k/ C,L 5 TR o O I o CD <br /> LEGAL DESCRIPTION(see tax receil9- 9 Y93 /y / TOO <br /> pt) .S a T Lf O/ R ! 4 W (o'O A4VS Z SSU /Y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 'V p Z7 00 CA c o <br /> TYPE OFPERMIT(S): _7 <br /> [�p / > 0 <br /> FILLING/GRADING 1:1 CAMPING UNIT ❑ SUBDIVISION Elr t GO@, &6 T n <br /> STRUCTURE/ADDITIONUSE: CAB ! N y <br /> (Hom^e/Cabin;�CCommercial Business;Bedroom;Deck;etc.) Cn <br /> BUILDING CONTRACTOR: NV RZ N L�N11 7 N C, <br /> iu <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) m <br /> O ` <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 Z �^ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m C <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. O <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, CONTRACTOR, ETC., THE PLANS C <br /> MUST BE SIGNED AND DATED BY THE OWNER. --3 <br /> g� \ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI � !r <br /> NEEDED. r� <br /> Ir <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J JIM CONDITIONS OF PERMIT: + ,' ''Gj i O 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER BUR COv / p)))�•••lll' <br /> ISSUANCE. <br /> 2 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ONlN�] NTM ^ \ <br /> l tom, <br /> PERMITTED. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATE <br /> 5. E AC AREA. Ca�.0 l /v <br /> 6. S' _ �/ U�l /4- m oni M a i mA <br /> 3 a m x 2 � 3 <br /> 7. a cCmac9 <br /> Z ' No : 0'o <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZZ :ZZ` : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm�`, d, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <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 C <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person t have acce s to the above de ribe at any reasonable time for the purpose of inspection. <br /> m ti : <br /> T <br /> m o : <br /> CD <br /> SIGN HERE 6 <br /> (signature of o r r 11 g contractor) (date) ` a <br /> ZONING ADMINISTRATOR <br /> 6969 <br /> N (TNNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED W N <br />