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V / Gc&. <br /> Burnett Cuunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U ci <br /> APPLICATION FOR LAND USE PERMITS <br /> s SZ, <br /> �"R�V�lI< 5'TREWE <br /> OWNER TELEPHONE - 7/ 7-3 <br /> 0 <br /> L�1D/1f' Tc/ �1.1� f�/� f� W-18 <br /> . 17 � <br /> HOME ADDRESS A0 d ,ls�/.[ K �rtW 01WF, DAM� W-L CD O <br /> EMERGENCY/FIRE NUMBER a` a 3 ROAD NAME r <br /> LEGAL DESCRIPTION(see tax receipt) V O L-umo ' I LOT 7:9. ) m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X PRIVY ❑ <br /> o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 1:1 CAMPING UNIT ❑ SUBDIVISION ❑r,.v /�,,,�n J <br /> STRUCTURE/ADDITION USE: ConitiFRT CIST105 DECK 70 A090 C[ 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> � v m <br /> BUILDING CONTRACTOR: �IItiI �L�--tom <br /> 5 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m3 , <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O f. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m C <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z� <br /> n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). <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 ` Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. (vl�' N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CQW R, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. Oo o <br /> J o ? <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT ATION 0 l�0 <br /> NEEDED. � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J Oct � c�' Z <br /> CONDITIONS OF PERMIT: BUR J �"w� o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITZOAr COUN <br /> ISSUANCE. r y/NO ry (� <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 REQUIRED WATER a <br /> SETBACK AREA. <br /> 5. n /C _ qo v <br /> l7L X 'V0r DOD01 1 0 CD CL O m <br /> 6 .m < 3 0'. CD 0nm <br /> -o m C y �" o f <br /> 7. Z I N m o 1 <br /> m <br /> p <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 c <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m 0 m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> -n <br /> CDm <br /> SIGN HERE OC — t "' ' <br /> (signature of owner or ing contractor) / (d te) <br /> ZONING ADNISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />