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C 2LNV) <br /> Bui`nett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 ` <br /> COMPd ITEWSCANNED <br /> OWNER &poEg $Malt <br /> Gal /1J ryLle-G.� TELEPHONE <br /> o t <br /> HOME ADDRESS i• <br /> rn <br /> EMERGENCY/FIRE NUMBER / ROAD NAME a ...Z <br /> 1 'Z 4Z il�e� 028-4118-curl -ate ea) `.o 5 _ <br /> LEGAL DESCRIPTION (see tax receipt) � <br /> S�` 41,..) t g '`lam i`i �tTZcrv. >P cn <br /> i a ;- <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑S) 0 cn g \ - <br /> TYPE OF PERMIT <br /> FILLING/GRADING 111 CAMPING UNIT ❑ SUBDIVISION ❑ fa <br /> w. <br /> //4.7 �� a <br /> STRUCTURE/ADDITION USE: Li ' 7 <br /> ` (Home/Cabin; Commercial Business; Bedroom; Deck;etc.)� �-✓4c,C) CO 1 , <br /> BUILDING CONTRACTOR: -- -�J /c ' 1 --75-- i 116„ <br /> k <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 11 <br /> -n <br /> X y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O 71 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :" <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ••- .1:'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. 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. to C4 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN . o ) <br /> NEEDED. 0. L <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o . <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 11. 0 <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. (1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE R?,,,,,,_EQUIRED WATER _ 7 <br /> SETB K A . { 7 <br /> 7-7,,A -( 0,-,7-r-e.--4-- <br /> : AL <br /> �0 �17 "�, „4m •< B n 2 %a m <br /> 'O N C O ”' 0 O 3 <br /> 7. Z N CD 7 -1 <br /> O X <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 2 D <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c g C <br /> ^ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mil) 53 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ..' w mo <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 above described premises at any reasonable time for the purpose of inspection. .n <br /> CD <br /> CD <br /> SIGN ,+� /0-17 <br /> `"' Hi <br /> •.\ (signatureo . ero ..d.' ,o"tor) (dat <br /> ZONING A _' / �.� � >I+I !f✓ t „ s v> <br /> / <br /> k---- . En c++Enbnv►rfl <br /> N N V1 N N Ui ut <br /> 91 (71 O r'1 CT OO <br /> 1 T o WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />