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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> fll <br /> C <br /> OWNER <br /> La rv,A T La rso P, TELEPHONE (7/s ,? 7_ y3Jc <br /> 3 <br /> HOME ADDRESS OM0.249 �,� ri'c '. S —/ v N <br /> i r � <br /> EMERGENCY/FIRE NUMBER a ROAD NAME V(? <br /> LEGAL DESCRIPTION(see tax receipt) 1� m <br /> �q <br /> CD <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ c <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADINGG ❑ CAMPING UNITE`/ S 134VISION El5 <br /> STRUCTURE/ADDITION USE: _ beck T c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;;tc.) Cn = c1\ <br /> Y� <br /> BUILDING CONTRACTOR: d rV n T Lg rso r Er <br /> v <br /> CD <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. <br /> °MH v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0c <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m I <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)i BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. sos <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENm C 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z w <br /> CONDITIONS OF PERMIT: o <br /> i I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �y �! <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. li N VeQ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NSTRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUI R <br /> S TRACK <br /> 5. ��� S/ <br /> /UDMC'6n YH4r ey l z -0ndo ov <br /> m m 6. 53�10 4 / - It' - -�*'3' & <br /> a m <br /> 7. /p M <br /> -_ rn: m <br /> I declare that this application (including any accompanying schedule) has been examined b o the t of c ` ? C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible fo t Me3ura o <br /> all Information contained in this application(including any accompanying schedule)and I furthe m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determin g wheZFtbr to is- d <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to hav&access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> m : <br /> SIGN HERE <br /> (sign to o w eror Yblldln o tactor) (date) !� <br /> ZONING ADMINISTRATOR a c ,n <br /> lJ <br /> _lwv+CANr)cn^' N P N P En <br /> P <br /> V1 N O(!1 VI O O <br /> 0000000 <br /> TO NSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 o c <br />