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d-)'C- 6c7� <br /> Burne"ounty 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> H <br /> C <br /> OWNER TELEPHONE �✓)` Q 7a�_ <br /> HOME ADDRESS \ S������ S� �1 C�qw1 9 <br /> L r e <br /> Q1 © o <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> s V l0 spa <br /> LEGAL DESCRIPTION (see tax receipt) 411 -c3- G`O I EN <br /> c. C.��n'd 177)10 <br /> ND � - Ppl Crop, lb4 (t+Q 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCES ORY STRUCTURE ADDITION ❑ PRIVY ❑ N ° <br /> TYPE OF PERMIT(S): rr <br /> C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ w <br /> STRUCTURE/ADDITION USE: <br /> 11 (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: 1A-)% P\aok RCD 1f r5 l ciOl]s'lr. nc-'. lit <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)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. <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. NDO <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. U3 0 ` <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa 0. <br /> NEEDED. <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ` <br /> CONDITIONS OF PERMIT: <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. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. N <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED IT H WATER V <br /> SETBACK AREA. <br /> 5. <br /> 119M <br /> � vnr � o �o � <br /> 6. 1 , fo b 3 r5- ; <br /> AUG <br /> N C N N > > <br /> 7. 3 � 194 0 " (� U3 ,4 <br /> _ Cn: M <br /> 7p� m <br /> I declare that this application (including any accompanying schedule) has been exa r"/ o the be o my 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible ��I.1p/_�p�uracy of � o E <br /> all information contained in this application(including any accompanying schedule)and I fuTfMNls re that f recognize � : m : : : M <br /> 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 m E <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 to th bove described premise at any reasonable time for the purpose of Inspection. T': <br /> m <br /> CD <br /> SIGN HERE <br /> • y '� / <br /> (signature of ow r ull on (date) <br /> G� <br /> ZONING ADMINISTRATOR <br /> M CA J <br /> N L"c) CA P <br /> (71 (71 O Vi V7 O O <br /> TO SHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />