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l3urnett County 7440 Co.Rd.K, No.102,Siren,WI 54872 Office of Zoning Administrator '1 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> - r <br /> VT <br /> CID <br /> CL <br /> OWNER OX QV1✓1 �- L h t7 h'\QS TELEPHONEE — <br /> MAILINGADDRESS �20 mkyiy �/ La4-c. pR. Lyw Lr& l A104j, y FO <br /> l_ <br /> 7 r m <br /> 0 <br /> PROPERTY ADDRESS X4.517 E. Rice L ke Fd 5poone� w.r svgol 01 <br /> IF/'+ Pwc ce I N c • I <br /> LEGAL DESCRIPTION(see tax receipt) PCL Gov LoT ,2 Des e LR 4 yS- 61-02b 2-39-W-10-0 _ � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION 1151 pX�Z' D3�i0O ` rn <br /> TYPE OF PERMIT(S): ❑ <br /> n F G ❑ CAMPING UNIT ❑ S �/'O' .. 1� t� _/� y� Iv °. <br /> STRUCTURE/ADDI-AoN6kE�M e)LOT) l� tS i 5. <br /> �.Z 4 ACU 0, TS4 e¢1 0' <br /> (Home/Cabin,Commercial Busi e�ss; 7S Bedroom; Deck;etc.)Y.-7-,5- 7 rn <br /> BUILDING CONTRACTOR c v kect& 0-411'aS�GLC JLS //S" 021--19-) 3 Z d <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. N <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> c) <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. <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 -(Z. <br /> MUST BE SIGNED AND DATED BY THE OWNER. --q 1 <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z f <br /> CONDITIONS OF PERMIT: U <br /> _ o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEROIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY / 3 <br /> PERMITTED. BURN <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED <br /> SETBACK AREA. �y /J ,/n /� N�NO UNry <br /> 5. ( �/ 111�� �i4- C to ��� I'S- 1 ,1l <br /> / m W ori C a f m <br /> 6. <br /> Z m y o 3 <br /> =7. o <br /> I declare that this application including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n to C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize a m C o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D ' <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 p <br /> authorized pers have access to the above described premises at any reasonable time for the purpose of inspection. T m E <br /> CD 0 <br /> SIGN HERE AK� J�` m m <br /> : <br /> (signature of ner or building contractor (date) a <br /> l <br /> ZONING ADMINISTRATOR <br /> to to <br /> r() (T Cn O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� <br />