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• a <br /> Burpett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> LG.;2-3 193 <br /> OWNERr-�C�krSKl TELEPHONEir <br /> m <br /> HOMEADDRESS 7yv5 SowYti Rxr` c . /L. v O <br /> ` cvnM X179 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER a.7 14 3 ` ROAD NAME Q O(tTUT j L f}►JG <br /> LEGAL DESCRIPTION(see tax receipt) 415-1 3, CSM V0 IS RhGts %c(ylil OP OAt�e�Np y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ I v <br /> TYPE OF PERMIT(S): �^ Or <br /> � <br /> FILLING/GRADING El CAMPING UNIT ElSUBDIVISION ❑ vJ 5 <br /> STRUCTURE/ADDITION USE: S'T'OP-A6 es' 0 (t , <br /> (Home/Cabin; Commefial <br /> Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR:— S t .(JI;0 e HCS L E S Cop—P.ry` . sr. <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 -' <br /> °0 N C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o. <br /> r/` <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 E <br /> NORTH(N). N o , <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS J 0 b <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ? W' <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1 <br /> CONDITIONS OF PERMIT: rQ.. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. OvN 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY -l r , , <br /> PERMITTED. W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> z ;o3? �� m <br /> 'r3EE a <br /> 6. mcH !" es3 <br /> co <br /> 7. <br /> o : <br /> = N : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c� C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C 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 y <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. V <br /> ID : <br /> m <br /> SIGN HERE ��rJ 3—a $-99 <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �///� ILJcJI'1 . . . . . . . w <br /> SS's t wcnFnfnfn <br /> �O CI1CI1NU1NN ( <br /> N NO0P <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 c no no co 0 0 <br />