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07t, Ow <br /> 'T <br /> EJrnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> ,n O <br /> N <br /> C <br /> N <br /> O. <br /> OWNER -47 Erq FSSG iL TELEPHONE ���_ s' 96�� <br /> HOME ADDRESS Zoe 0a,,l AQ,4 G ND l/V.Wl041 NN SS`��{ <br /> srt / �0 <br /> � <br /> ; <br /> EMERGENCY/FIRE NUMBER �` Olga 3 ROAD NAME rgAa/- Lq kG /7r.'de V <br /> TWAT <br /> LEGAL DESCRIPTION(see tax receipt)` �� CpyCY/brC,yT / S Ff- SfGI/�t Sc c �7 R4?Afef I <br /> c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ �sG1'sS c <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ / <br /> STRUCTURE/ADDITION USE: 4�id T a't pit qre <br /> (Home/Cabin; Co ercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: Sa+n G E <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O ir <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n 1 <br /> n "(ZZ ) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C fiE <br /> 0 <br /> NORTH(N). 05 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. M <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS ) ? pV 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. V� <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 r Q <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 � t <br /> PERMITTED. 1�+ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. yy <br /> 5. m � m � �+ MnJm <br /> 6. m � 3 CL <br /> 'Mc:w'ooNor�d3 <br /> Z : N N O O V7 <br /> O : CMD <br /> � <br /> 7. = rn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t7 c A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ro 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 O <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 the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> m : <br /> SIGN HERE <br /> (signaturfe owner buildicontractor) (date) <br /> ZONING ADMINISTRATOR `/gym rr^� )f��T1 1 "fn cn fn v�cn dr <br /> N N UN N Vt ut <br /> N (n O Cn (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �< o 0 0 0 0 o a <br /> 0000000 <br /> oagn <br />