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D/L' C"Y46 <br /> Burnett Csounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y O <br /> CD <br /> CL <br /> OWNER -STgKLCy ✓, Afes //ezz ,,p TELEPHONE 19l-6 �\ <br /> m <br /> HOME ADDRESS Q �/� f✓� •��+c�d�����,. ! - O <br /> s � <br /> EMERGENCY/FIRE NUMBER '13L�3 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) ^ C <br /> V1 c <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 1:1PRIW ❑ CO 0� <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ L <br /> S. <br /> STRUCTURE/ADDITION USE: ���� d•�..Yy� � (1 1 / ' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) / (n <br /> BUILDING CONTRACTOR: <br /> 1,W k-4- �D95 f.2�/CTlDA/ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O `m r <br /> TI o. <br /> 'r1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ` A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 IM 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. P <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. �U <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o c <br /> o f „ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN0 <br /> cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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 r ry <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> LL 1 /� • � -0 (fir �pO�O <br /> CL <br /> 6. `7 nll , (0-78 �p � anNNQ_ <br /> J J 9 mcoi7. ooS <br /> p : <br /> - 0: <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m E � <br /> that this information I am providing will be relied upon by the County of Burnett Wi co sin in determining whether to is- m 13 <br /> sue a permit. I further accept all liability which may be a result of the Cou �Ve <br /> �qh a n I am d <br /> providing in this application. I agree to permit county officials charged w i rothermauthorized person to have access tot above described premises at any r 1 s ection. <br /> CD <br /> SIGN HERE <br /> JUL I <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �Ujm an;q2,j BURNETT COUNTY <br /> ING � `"`"`"" O , <br /> . N NOf NN(T ut <br /> P (nONmOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />