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Bucriett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Ln6cTn�p <br /> Office of <br /> APPLICATION FOR LAND USE PERMITS Zoning Administrator 3 0 0 <br /> N <br /> N <br /> C <br /> OWNER TELEPHONE <br /> AVSHOME ADDRESS �hrm S S'Y3 9 O <br /> EMERGENCY/FIRE NUMBER 956 1� L <br /> ROAD NAME G / <br /> LEGAL DESCRIPTION(see tax receipt) / any / U� (s"rry W <br /> V (� !-0 .dcaYwn / A <br /> V) \l <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY o <br /> TYPE OF PERMIT(S): �WI c � <br /> FILLING/GRADING El CAMPING UNIT ElSUBDIVISION ❑ SC.-O a <br /> A,l / <br /> S. <br /> STRUCTURE/ADDITION USE: SdegM A2YQ =a1_e ><e �X(SIi n5 C6 utr�ri (."�(hc� /,�)(�� o' <br /> f (Home/Cabin, Commercial Busine s; Bedroom; Deck;etc.) ' <br /> BUILDING CONTRACTOR: � W ^)E ,,jj,� J N <br /> /yYi L/S O7� <br /> fiC <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR � v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, m <br /> 3 <br /> 0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c ^ <br /> O CL �{\ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 2! v 'ZZ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). (}j <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ' 3�k' <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS,ROADS,LAKE, LOT LINES. r� <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. YJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. CG <br /> � 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <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. (j , <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> s. ►�"Xl Y( IQdcQ�flo�. D n (� P#rM l �� uc�rrri F�c�c(�> '� "'�(u�`�E/ d 3= Ni <br /> � /�GG l/ 1?G� <br /> 7. 9'p/o <br /> o � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ai 0)-'T <br /> Ii m <br /> c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize I 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- <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 i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access tot above described premises at any reasonable time for the purpose of inspection. <br /> CD : : : : : : : <br /> SIGN HERE <br /> re o er g contractor) (date) N. <br /> ZONING ADII ISTRATOR L`1: <br /> ce4A444049�� <br /> N <br /> K) Ch N N(nW <br /> V1 (� O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o 0 0 <br /> 00000oo <br />