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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 /> toy- 5/ _ ?�3 �buD ° <br /> - <br /> /� LAKE_p�i s) d56 � <br /> OWNER G)ERRtD A,* Ro5E MARY A. kLw_8K; TELEPHONE Ncxn�— (lrj,- C)q j5 1p575 <br /> 7.RKf— 28825' Mr.NEILUA �P-CI-E DAN Y -1W= '`� o l�3`y� <br /> HOME ADDRESS HofRF - 1430( Aha 9t � mp4)ETt7nlKAI nIA) ��i327 9 O 1 <br /> F <br /> p /fE CIJA rE ✓I_ T D <br /> EMERGENCY/FIRE NUMBER agUrj Mr R L� ROAD NAME <br /> 36--9c. 3y 555 5361goq S'3(vATl{//A � 4CRES.07 <br /> LEGAL DESCRIPTION (see tax receipt) a—�/— — �P— O 3 O O Glyf T., <br /> / C5!>1 (P P tIJ� �� <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ❑ i W o <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING X CAMPING UNIT ❑ SUBDIVISION <br /> a .❑ To �Or1Jt"DbxTIo <br /> STRUCTURE/ADDITION USE: IED ROOM pFCK !j <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> 5Ee.F — GEuE2AL sus' fo BE rT� Nom_ C3 <br /> � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR ID <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 5e /j -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) (���f 0 <D (\ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T�+ T v �1 ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �� X <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 7 <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. � � C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I" N W <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. <br /> 'r ti 4` f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V RIFICA rE EN o <br /> NEEDED. CAJ <br /> pp ,, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. $ <br /> Z <br /> CONDITIONS OF PERMIT: 0(}}� 1 <br /> `W[ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYSBOF P CODA, <br /> ISSUANCE. ►►.�,,IAV' N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIINNEvI,vG <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m �o a v v <br /> CD <br /> 7. a ° y y j S <br /> Z 3 <br /> : m o <br /> P <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (} Cn <br /> m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of �v d C <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- <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 <br /> m : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> A. <br /> 2 <br /> SIGN HER �ag1�r� <br /> wn <br /> g ure of ouilding contractor) �I=--u (date) <br /> 4: <br /> ZONING ADMINISTRATOR <br /> °' Q; <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,�� nom- w <br />