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0--/2 6d >—Itp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0z <br /> APPLICATION FOR LAND USE PERMITS 3 � <br /> N7 0 <br /> 1 <br /> OWNER �QAGD o� QCG,I¢ t..�K(SP)�1tJSe/� TELEPHONE 71 S -5L�(� 6ZJZ C3 <br /> o C)o <br /> HOME ADDRESS <br /> 5 74 3 u?4(7- L44&1-9 asay iSic,- 5¢Q I b g <br /> EMERGENCY/FIRE NUMBER — ROAD NAME '5-rA?F-e HL�h m <br /> LEGAL DESCRIPTION(see tax receipt) 5 W '/({, "r +1A) w <br /> m <br /> DWELLING/BUILDING LV I'GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ElPRIVY El <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> N <br /> STRUCTURE/ADDITION USE: 0 <br /> D (Home/Cabin; m <br /> Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: paryS I <br /> -7f5— 2.-68'— 9500 <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> :O N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m v °p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :^ <br /> NORTH(N). W o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m M \ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v� <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( c <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. N <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. U3o <br /> v (u <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN czr <br /> 0 <br /> NEEDED. KJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> 0 <br /> CONDITIONS OF PERMIT: � <br /> 96 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITV' Q <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 /> SETBACMREA. <br /> 6. t�6>�g-10-c)q Z 6, /"," ;U -V 0 r.- 0 a -0 <br /> c H . c � 3 <br /> 7. <br /> z : " � '10q <br /> o M <br /> =rn : m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ij c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m - : '• <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the ab escribed premises at any reasonable time for the purpose of inspection, m <br /> m : <br /> CD <br /> SIGN HERE <br /> (signature of owner <br /> or building contractor) (date) <br /> ow <br /> ZONING ADMINISTRATOR l l/I� I-' i I . . . . . <br /> to fn fww to <br /> N NT NN <br /> O ut <br /> U1 U1 U1 U1 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O o 0 0 0 0 <br />