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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS <br /> y � <br /> T p � �� y p /� ?r ',577 <br /> L <br /> OWNER ,Z O/V5 C IX W�,t^'/'C E Af R PR,47-TTELEPHONE T/.u�" 6viz -ZJ 7 7 <br /> MAILINGADDRESS 1 57 COU/V7 ROAD /_ SPOONEfC� te, ,P,�IpOj CD <br /> ^ ,^ � r m <br /> PROPERTYADDRESS ,jr4M <br /> LEGAL DESCRIPTION(see tax receipt) LOT <br /> csyn , 5 <br /> i �J p� <br /> 2 r <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION ❑ �o <br /> TYPE OF PERMIT(S): co <br /> � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 12XI,6 sTmA -E -5H Epi' o � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> CD <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. rt - <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M ti <br /> O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �D <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 03 <br /> CENTERLINE OF ROAD, (C)BUILDING0 <br /> S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF )t <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 00 (> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. a ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C4 <br /> CONDITIONS OF PERMIT: P 9 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. tyI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m cw m ODaO � <br /> m x3 nm F °. m <br /> 7. N C N N O <br /> Z y N N O <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my N s�v O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m u C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize _1� m rM <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- T in 17 <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 G : o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ? CD <br /> authorized person to have access to the above described premises at any reasonable I ction. <br /> nE <br /> SIGN HERE ) C j I `D a <br /> Vi n <br /> (sijinatuOg of o ner or building contractor) date /�` o i <br /> T ( ) W i i i i <br /> ZONING ADMINISTRATOR V v � 2 2004 <br /> '`� fA 69 69 EA N <br /> o o o <br /> TOWNSHIP PERMITS MAYBE REQUIRED 'UGINETT COUNTY �. <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSIUARAULNG <br />