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IOU <br /> Burrett County 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 /> 1 /mil- ('qt-0��/� H o <br /> a <br /> C <br /> /n '/ nl <br /> OWNER �� ! ,QAJ/tJ e,F,1<e WYC 1F/C y TELEPHONE (,�J — (pl�_')_ A-40 o <br /> HOME ADDRESS <br /> o � <br /> EMERGENCY/FIRE NUMBER $'a 7 ROAD NAME �t 7C I'" d r% T <br /> {ef {kph oR'To6�AadwGCCNes 5-R3 T-�/r1 � I(oW I. L7LAc• <br /> *1 44 <br /> LEGAL DESCRIPTION(see tax receipt)k,,tb (3 /4S- D Cn <br /> CD0 <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Q N <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAM UNIT ❑ SUBDIVISION ❑ S. <br /> ,KJ/Y//� ,�/� S. <br /> Ln <br /> STRUCTURE/ADDITION USE: t'N e o <br /> 0 <br /> AA <br /> (Home/Cabin; Commercial B iness; Bedroom; Deck; .) m W <br /> BUILDING CONTRACTOR: n6e,+ 1a-od "4kyaoutc-s lwIW36lltii/(j)AIA Cr <br /> — <br /> go v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om d <br /> 'n a <br /> 11 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �° <br /> NORTH(N). C Q <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m UJ <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> N p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS l <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> I O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: tant1 <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. � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY; <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQ I E <br /> SETBACK AREA. l�^J <br /> 5. <br /> _J n� O O � <br /> 11 . m <br /> 6. AUG 2 Roo, W c N Q. 3 <br /> TT <br /> 7. BURNS y o : ' <br /> - Cn : [ <br /> I declare that this application (including any accompanying schedule) has been examined by me y c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail ahd curacy of �+ c <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 Burnett Wisconsin in determining whether to is- O <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 m <br /> authorized person to h accesp to the a desc 'bed premises at any reasonable time for the purpose of inspection. -n <br /> SIGN HERE <br /> signature of o or building contracto (date) <br /> ZONING ADMINISTRATOR ��� <br /> N NCnNNITN <br /> Cfl CII O N Gt 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 00 0 0 0 <br />