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1. Majyo <br /> i3urnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -o c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O Vr\ <br /> N 1 <br /> OWNER O d V/ D M 0 S E.S TELEPHONE �� 51�j n ((J, <br /> HOME ADDRESS <br /> 2 30 �t�ne c �5- Sq <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER Z7q3b ROAD NAMEStone tc <br /> 33-r� / 28 30(, S33/rVolk�6 flcrEs -6g <br /> LEGAL DESCRIPTION(see tax receipt) Z-q t) . -3.3 -v a 3 yo off�t�It�T cs ✓3 PYo �Asm CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ 40T? 1 rn <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ AMPING UNIT ❑ SUBDIVISION <br /> - ❑ C q <br /> STRUCTURE/ADDITION USE: �r_ra lL V /l p y // <br /> (Home/Cab' Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <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. T 3. <br /> O <br /> in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m d \ 9 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 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 �1J <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. V N , <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, RACTOR, ETC.,THE PLANS I Z <br /> MUST BE SIGNED AND DATED BY THE OWNER. l kio <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE CA o <br /> NEEDED. Rc�r7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Oe, o <br /> J z <br /> CONDITIONS OF PERMIT: BUR 9 � �/ p ` W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERIVT�F -r' �t,T. 7� �'I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE`E10j 6 v'r' f" d I w <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. (` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. / <br /> This structure to be used as private residential X v 0 r y o y f m <br /> 6. garage/storage only. Not to be used for human 0 3 a 0 0 c. ;a <br /> j5 : (D C y N 0 = 3 <br /> 7. habitation. N `D <br /> o T < : <br /> o <br /> = 'cf): <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 A <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize \ ` <br /> PP ( 9 Y ) 9 D C- 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 /> 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. `D <br /> T <br /> �J p <br /> CCD <br /> D <br /> SIGN HERE WWT�I� J0 <br /> (signature of owner or building contractor) (date) <br /> 1 <br /> ZONING ADMINISTRATOR (J1) <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />