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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vO Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> N <br /> P Q <br /> OWNER to 4e- 4-U i e, TELEPHONE o O <br /> I 1.- m <br /> MAILING ADDRESS X352 8 kaweh {,.C lr wbrA 6r 41e-L aei , Kto_ S'12 y <br /> Q� m <br /> PROPERTYADDRESS 52-0c) Cad q 13�A <br /> (J Y <br /> `n <br /> l <br /> LEGAL DESCRIPTION(see tax receipt)A) LAX C-$h1 �/ P115-S U <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION QL-J UI ra 0 fi <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> ag� dt�.� t�si CdQt.l� y <br /> STRUCTURE/ADDITION USE: Nr "c"—s' w� <br /> eCZ P <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR N J <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T a <br /> 11 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 9 <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRA ILLED. N 9i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER S 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'I, � q f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VEfk ICATION MAY <br /> ,BE DONE WHE <br /> NEEDED. ���� G f 2oa3 C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a Q O <br /> CONDITIONS OF PERMIT: BURNE-r° C®UNT y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI?ONING 6` <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. , d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. v <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. / ,r <br /> 5. // •� �+ jjeat l'borYZS 6'a �e <br /> �Xrs SfF�rT� � Gt!^ J/� r � X C) rDODO � <br /> s AI � Jv0 a- /fntiha� �b07�✓)S . m = 8 0 of m <br /> 3 n � x m A <br /> rav/ e � Nyo � 3 <br /> 7. Z N m 0 <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w 0 v, <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize M 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 m <br /> providing in this applic n. I agre o permit county officials charged with administering county ordinances or other � <br /> authorized person to h v acces bove de cribed premises at any reasonable time for the purpose of inspection. ° o <br /> CD <br /> CD m : <br /> SIGN HERE S r 2/ O 3 <br /> (signatu of owner or u' ing rac dat \ n <br /> ZONING ADMINISTRATOR <br /> D3 z� � <br /> GfAu,fAfA�N <br /> N U N N O O <br /> Vt O N(T O O <br /> TOWNSH PERMITS MAY BE REQUIRED <br />