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BUrnefi biounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 T <br /> r <br /> N O <br /> N <br /> C <br /> OWNER Jq YN PSI S g to&CL K TELEPHONE -715 <br /> m <br /> HOMEADDRESS /4'7 R;✓Fr D-" 1Qi'Vfr Falls, Loi S-4 z m f <br /> CD <br /> r CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME ka`/oleo Lq Ke bbl• o <br /> L 0o+ A CSM V. S , y�- i�4 din Govt, Lots 44 ctnot pgrt of L0-f 3 > <br /> LEGAL DESCRIPTION (see tax receipt) jg,Q,, CSW► r V.St p, I�1 �F IS CPec. �-btb'V I Doc.No.33 7 USoJ W <br /> I m <br /> : +r <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE X ADDITION El PRIVY ElO 0 <br /> TYPE OF PERM c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: Ga o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Doh Proff.t <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n — <br /> O < <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n a v1 <br /> -n 2 <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 m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <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. IN Q <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. t <br /> � o <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: 0 rDT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �q v/ <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 WITHI ��QUIRED WATER <br /> SETBACK AREA. <br /> 5.� f� Q � WmaCaEm <br /> 6. V <br /> CD. <br /> c v am �c � ^ '� <br /> yS ) <br /> 7. ��� V / O N O = ;13"an I n . <br /> cf) m <br /> I declare that this application (including an accompanyingschedule has be b me an o thVaracy <br /> of m A <br /> PP ( 9 Y ) ifY y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am respon's�(6bTTeellff�� rrJJetail and of R 0m <br /> all information contained in this application(including any accompanying schedule)ar�QJl� agnize a (D <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsi rminln 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access tot above described premises at any reasonable time for the purpose of inspection. m <br /> mE <br /> lq� re m <br /> SIGN HERE ?`3r/ <br /> (signature own r or building Contra cto (date) 64 <br /> ZONING ADMINISTRATOR Chi (�? . <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />