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YLC..fi>'►L_� <br /> Burnett 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 /> lq/ -(�77-72// Gd T vJ <br /> .177 <br /> OWNER O G,CSLEPHONE36,E <br /> / w <br /> HOME ADDRESS �jg� /�`7'L.0 I ,�/ i CCJY lA&Am l �3 � <br /> EMERGENCY/FIRE NUMBER 12,0 72 ROAD NAME �� O <br /> / <br /> m 7 ��4942 Afl- (//"DY Zor LEGAL DESCRIPTION(see tax receipt) - T3w <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): -r ' <br /> FILLING/GRADING [j CAMPING UNIT [:1SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: !- G7)T/SLI <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: Mmm -AS ego, - lt//�GaJ2NYel �SG N/OUG�S <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 00 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. N <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. Q o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( " <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (� <br /> PERMITTED. rVJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. tt - <br /> 5. �OC(fl�/�PQ�CGI Lur�LaiON S Q/U fl S r �t6�A teugN�e 3e� `r <br /> I_ rrewfi µ�Inlr�"-�' ��� m d d m <br /> 6. _ rypyl/NTCACcA/Lti rr ^A� f1i)CGe2 2Sl��O �/U v CL m CG <br /> : <br /> Cn: m <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined -Me and to the best of my C p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 ' S <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <br /> sue a permit. I further accept all liabilitywhich may result of the County of Burnett relying on this information I am <br /> providing in this applic agr to permit c officials charged with administering county ordinances or other m <br /> authorized a s o the above s Ibed premises at any reasonable time for the purpose qf inspection. m <br /> m : <br /> m <br /> SIGN HERE � <br /> nature of er r building contractor) (date) <br /> ZONING ADMINISTRATOR . . . . . . d+ <br /> cAwwww4� <br /> N N fn N N(n N <br /> (r fl1 O V1 Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 00 0 o 0 <br />