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Bllmett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> \l yy^, <br /> OWNER �i M f 1\ASZoA�.1`�IISON TELEPHONE USt _H30 �_57yq v \ w <br /> HOME ADDRESS 14 6 Ll A 1�A�Q E,MO f 1yl H . .5-s-owa, <br /> EMERGENCY/FIRE NUMBER ROAD NAME bQR ojrl Lit o <br /> G o y Lis 5�c. '357 TL4w 9 14 o No.E s 1(o u/ 1 <br /> cn <br /> a y. <br /> LEGAL DESCRIPTION (see tax receipt) Lo-(— Z N(01 Zz(O J <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTUREADDITION ❑ PRIVY ❑ 1 rn <br /> TYPE OF PERMIT(S): 9,1 c <br /> FILLING//+G11R__A�DING ❑ CAMPING UNIT ❑ SUBDIVISIONEl <br /> n <br /> STRUCTURE/ADDITION USE: !r5%�.� w'VL 1cA I)a �- T)4AAc1 Q $AMcL ° <br /> (Home/Cabin; Commercial Business; B room; eck;etc.) to <br /> d <br /> BUILDING CONTRACTOR: <br /> (Uw N aY�\ � <br /> v <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 /> 0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> MZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m c(, 3 <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. I 0 <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 5413 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 2 <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. I I <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER v 0 <br /> SETBACK AREA. J� �j �/ '/ ' l / 1,•) <br /> 5. -�l�o� �P rY.tZC/t3 IlC,o7 Q/f M/e /A �&Ze <br /> A me n dr * L O <br /> CD • m m m <br /> 6. v W CH1" o � � <br /> 7. Z : N wo = -i <br /> =co m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my r_ of c C <br /> W <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize PP C 9 Y ) 9 M E f E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 �1 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> rn <br /> cn <br /> SIGN HERE 41 Z Q f7 <br /> (s re of own o uil i c t ) (date) <br /> ZONING ADMINISTRATOR .J -7J <br /> fn cnv+w <br /> ha � <br /> rail � 00 <br /> TOWNS IP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />