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urnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> fR <br /> /// �( /� j ? c <br /> NNER �or Tl�crrL loM1 1 t c G�G{S 1 �rc�ea s TELEPHONE 3)L6 a33 7a`7 0 J <br /> v <br /> CD <br /> 41LING ADDRESS p QoX ,273 a 160 T6 W e r ►� F f (�yso� �n 55135 O� <br /> 20PERTYADDRESS X fjo <br /> �.�asg La�Cc .L #-3 G5� 33 V U, Qby-6 5 GLj, <br /> � 1 ,/ � w <br /> ?GAL DESCRIPTION(see tax receipt) (� oC `� "�' � <br /> m <br /> 3 cS V)62 P� <br /> DWELLING/BUILDING NJ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION I rn <br /> c <br /> (PE OF PERMIT(S): � n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> m <br /> fRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) m <br /> JILDINGCONTRACTOR: TAG, <br /> m <br /> PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> LEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> 0 vyi <br /> IRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T n <br /> m Cz <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. () <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 0 <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ` <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. o <br /> SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO \\ <br /> BUILDINGS, ROADS, LAKE, LOT LINES. V C <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N ( , <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> DTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER F CIf� RQMIE(yItAF N o <br /> NEEDED.iIS PERMIT IS SUBJECT <br /> IIJJ �J I <br /> DNDITIONS OF PERMIT: TO ALL CONDITIONS LISTED BELOW. MAR — 7 2W2 i o <br /> DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OIETT COUNTY / (\ <br /> ISSUANCE. 7 <br /> REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI&9NING <br /> NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. t <br /> S �[ o <br /> e I ��s e�� va r�C a/z2 SQ�/'ed - M d d >o a o <br /> ID3 am ni- s � <br /> C y O 3 <br /> 2 N W O ' O <br /> O -n";! m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> iowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of N m cc, v, c <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o v <br /> iat this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <br /> je a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> roviding in this application. I agree to permit county officials charged with administering county ordinances or other ' <br /> ithorized person to have access to the above described premises at any reasonable time for the purpose of inspection. rD <br /> (D o : <br /> (D m <br /> GN HERE 3— Ola`0'X <br /> (signature caner or it ng tr (date n : <br /> 1 . . <br /> DNING ADMINISTRATOR —�Z—ini 2, <br /> 63 fA Hi fA � N <br /> N (T N N O O <br /> TOWNSHIP ERMITS MAY BE REQUIRED <br />