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rql, "[= <br /> tet 04 <br /> Burpett Coanty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrat CD- o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 5 .0.. ( <br /> N W <br /> �'rA'/p� n �/� Ltd-7- <br /> may/(/�� �` <br /> OWNER 1' I T� T I E'_Y�cXS 11 Y l �'� l 1 - 5 <br /> TELEPHONE <br /> m <br /> HOME ADDRESS /V/ 1JJGQ • 'r1^Ur � o <br /> EMERGENCY/FIRE NUMBER ROAD NAME l-Il Wl6 // <br /> �.+ (ot $ I O�Ltaw � �f�+f lw �w�n <br /> LEGAL DESCRIPTION (see tax receipt) Ask t;vi of 4rlu* k1voO' e�;o �// d ol"n <br /> / y <br /> n <br /> a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): rr m . <br /> a <br /> FILLING/GRADING CAMP NG UNIT ❑ SUBDIVISION 5. <br /> � I <br /> STRUCTURE/ADDITION USE: o � <br /> Home/Cabin; Commercial Business; Bedroom; Deck;etc.) a <br /> m�,-k PiY��4 <br /> BUILDING CONTRACTOR: t 15 hA <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> r-tl N � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> -n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. P <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. gJ o <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 /> U3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr t <br /> 0 <br /> NEEDED. <br /> d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P I <br /> CONDITION$OF PERMIT: n�r' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT qJ <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 J C> <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDINIIG--RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACKAREA. <br /> 5. I b '�Y�'� V T <br /> IP <br /> 6. . m o <br /> C 0 o 5 3 <br /> O � m <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best ofmy ti <br /> ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofall information contained in this application(including any accompanying schedule)and I further declare that I recognize mthat this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- msue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am :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. <br /> M <br /> SIGN HERE <br /> (sl turf of owner or bu contractor) (date) <br /> ZONING ADMINISTRATOR en�'A^� <br /> N N fT N N 01 01 <br /> fr 01001 [TOO <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o �o 0 c 0 0 <br />