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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v "0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER OALF- tP AIMi L N0b1A,5 q✓ TELEPHONE 71Pgf5'-a>93 11, p �\ <br /> HOMEADDRESS A-Y 12SA �o <br /> EMERGENCY/FIRE NUMBER O.I ROAD NAME /'A K <br /> 1 ' <br /> LEGAL DESCRIPTION (see tax receipt) �O 17�� /�Crn <br /> � /� <br /> DWELLING/BUILDING <br /> ❑ GARAGE/ACCESSORY STRUCTURE IJ ADDITION ® PRIVY ❑ I - ) cn ° <br /> TYPE OF PERMIT(S): O Q <br /> FILLING/GRADING ® CAMPING UNIT ❑ SUBDIVISION ❑ n T) <br /> STRUCTURE/ADDITION USE: CA$ltl PQ/�ff/� a STORa66 �L06. 3�X j� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: E-QRL S,�-NSkN <br /> 12CD <br /> 17"..5 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/1 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T ' W <br /> .'t1 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 r� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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 J <br /> BUILDINGS,ROADS,LAKE, LOT LINES. t�' nJr} <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. X� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS u� 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <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 �w <br /> ISSUANCE. t' <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 lg7J <br /> SETBACK AREA. <br /> 5. — �� (/rY l . <br /> -G <br /> 7 � y �CD v Cir- DODOv <br /> 6. ����� �'nc��c� h bow' /b � � � a � <br /> m-rnC-D <br /> .m: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 1 Lj c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 7+' i a g <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m Ci p <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 /> 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 above described premises at any reasonable time for the purpose of inspection. m <br /> ID : <br /> CD : <br /> (A <br /> SIGN HERE �/�/� C/ U1t� 70-1-90�- d <br /> (signature o er or building contrac 1 (date) <br /> ZONING ADMINISTRATOR <br /> IY vl <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> G � <br />