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Burnett CoOnty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND US PERMITS 3 <br /> 5 3�18CaC,_bQ'rL6"hoclk� i r�i+ S0 ,6 41� <br /> OWNER J©L17 —Thief <br /> JYD LEPHONt/ CD <br /> m L. <br /> HOME ADDRESS <br /> 141 <br /> 1 <br /> EMERGENCY/FIRE NUMBER 7y96 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) L a L,:;t C31n �/ f3 Z�' 7U i CD <br /> f� c ❑ <br /> DWELLING/BUILDING El PRIVY fn o GARAGE/ACCESSORY STRUCTURE LTJ ADDITION ❑ o <br /> TYPE OF PERMIT(S): n r <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ v5i <br /> STRUCTURE/ADDITION USE /� �U o' <br /> 1r1'�. 0� <br /> �^ , (Home/Cabin; Commercial Business m <br /> Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR. n fii <br /> 3 A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a GCS <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE IF <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 3 <br /> v <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. \\i P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO v <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <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 PLANSCP <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o 0 <br /> v 9 'NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 <br /> NEEDED. <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. ��JJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY oO <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CL M <br /> 1�J <br /> /LlI� WlG1 <br /> 6. 3cpimo9' 3 <br /> ymo �� 1 <br /> 7. o 70 <br /> = rn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Elpmett Wisconsin in determining whether to is- <br /> Y <br /> sue a permit. 1 further accept all liability which may be a result of thistp�n��y of Burnett relying on this information I am d <br /> providing in this application. I agree to permit county officials chi-06014 -1/0m)nistering county ordinances or other ; E m <br /> authorized person to have access to the above described premises at any reaii n ll tl¢�for the purpose of inspection. CDi <br /> SIGN HERE Cn 4 CTs Q /© 02 07 <br /> (signature of ow or in t a �Q (d ) <br /> ZONING ADMINISTRATOR Cni. r 6 vv <br /> �N+.- to cw vi t»� <br /> /A/ r:up N (l� N N N (T <br /> un tnotn oico <br /> TO SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />