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e7LC <br /> Bt(rr,.%tt Obunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - e. <br /> o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER I�I TELEPHONE IS O o O <br /> o <br /> Mctl <br /> HOME ADDRESS 2 -75 2,g e5c c� rl 2'154714W 35 0 <br /> EMERGENCY/FIRE NUMBER '2752? ROAD NAME JeSc�l C L; LJlrl UC' gI, <br /> 1wp. 40 R I b Jesse cct �c�c��� ioa Lo+ �/ <br /> LEGAL DESCRIPTION(see tax receipt) 0 <br /> - <br /> DWELLING/BUILDING V GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cn 0 <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5. <br /> N <br /> STRUCTURE/ADDITION USE: Hamc, 3gK 64 (� 0 <br /> (Home/Cabin; Commercial Business; B Broom; Deck;etc.) m U1 <br /> BUILDING CONTRACTOR: yl)I n C� he, CD <br /> 5i <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n c <br /> M <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 Im n <br /> NORTH 0 <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 0." c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ) <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 /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W 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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr ° <br /> NEEDED. 2 <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 <br /> ISSUANCE. Q <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. <br /> 5. <br /> ID ID o � o <br /> m <br /> 6. <br /> a <br /> I; � a CL ;a <br /> � <br /> N O 0 <br /> 7. o y —I <br /> N ; m <br /> m <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 ii B <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m m 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 r m E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other to <br /> authorized person tg4fflve access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> 2rft /O 4 ; <br /> SIGN HE _ . <br /> n <br /> Nz/�& <br /> (signature o owner or building Vactor) (dat ) <br /> ZONING ADMINISTRATOR W 449 <br /> N N01 NN (n Vt <br /> Vt 01 0 01 0t 0 0 <br /> O 0 0 0 0 0 0 <br /> T NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />