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8urnet(County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> _ r <br /> N0. <br /> N <br /> G <br /> OWNER Ar/TEA,lIta %5AeA7-.=DeV TELEPHONE //lJ ��3s� f..3S� O <br /> m <br /> HOME ADDRESS j SS 9 O DGIto /,)4 kF 40 SPODWEX W/Sif S(Igo 9,649 v r 0 <br /> EMERGENCY/FIRE NUMBER ($LPj 51 <br /> ROAD NAME 6000 LAKE PO <br /> LEGAL DESCRIPTION(see tax receipt) 50 SE S " jq /T 3-7 R W <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ <br /> Cr <br /> TYPE OF PERMIT(S): iJ c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> LA. <br /> STRUCTURE/ADDITION USE: FAA/h .PODM q /VELD 8605' <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR:� Dffti�-SnAJ CDtiiS7�'r'/�/T/D/V Er <br /> .D <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 $ <br /> -n O Z <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 M <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. 90 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N i <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct S <br /> NEEDED. IImo``� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Yv <br /> CONDITIONS OF PERMIT: G <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUI D WATER <br /> SETBACK AREA. awl, j �Qzc <br /> 5. /9 / <br /> wd/'Bold bioddrne 6/�e llrrc�Se S. /e en CD zvn 20 m <br /> m �. m P1 li `° <br /> C/Fie 0 1�AU (D <br /> Z : <br /> y m —I <br /> 7. ulr . / P =y i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my \ c i <br /> jo <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O: m rn m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o <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 CD <br /> o <br /> authorized person t9 have access tot the above described preplNes at any reasonable time for the purpose of inspection. T <br /> m : <br /> nr <br /> SIGN HERE u <br /> / /99 <br /> (signature of eror In c r (date) <br /> ZONING ADMINISTRATOR . . . . <br /> w. <br /> tnwwfnfn� <br /> CA <br /> 0 <br /> T WNSHIP PERMITS MAY BE REQUIRED C' - /Qd /- 0 0 0 0 0 0 0 CA <br /> 000000 <br />