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B? .nett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> CD APPLICATION FOR LAND USE PERMITS 3. <br /> VX3 -36j <br /> OWNER � / Jv C TELEPHONE �j ,� US"�/ <br /> J r ' O <br /> HOMEADDRESS Von Shl ,,5/ g <br /> EMERGENCY/FIRE NUMBER 02S ROAD NAME /7 / <br /> Ir <br /> vLEGAL DESCRIPTION (see tax receipt) l (— f N� wlloa9 I <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREZ ADDITION ® PRIVY o o <br /> TYPE OF PERMIT(S): rVl Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: C/V-? ' A TJ(r( k/ D?GT/ 0 <br /> (Home/Cabin; Commercial Bbsiness; Bedroom; Deck;etc.) v� <br /> m <br /> BUILDING CONTRACTOR: 'DQ (t) &g Z�.! !v <br /> v <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. T <br /> -n <br /> A H Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T CL <br /> '—r o z <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 <br /> NORTH(N). y o� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. Q P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO p1� <br /> BUILDINGS,ROADS, LAKE, LOT LINES. N <br /> S. 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. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �O <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 d <br /> ISSUANCE. I, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 \ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. I(J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER U[\ <br /> 5 <br /> SETBACK AREA. ,� j &Ti <br /> Gt.lc Q`��a <br /> ' � /? Zee <br /> CL <br /> 6. f'LQ� ' m � 3 CL CD <br /> m c0 ' SO 3 <br /> 7. o yfD� of <br /> ern: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> CD <br /> 49 <br /> SIGN HERE <br /> (signature of ner or building c3%L4izL; <br /> (date)ZONING ADMINISTRATORd+ <br /> to to to to w cn <br /> ((V�!N N Vf NNaTP <br /> l![T [T o P 'O 'P O O <br /> T NSHIP PERMITS MAY BE REQUIRED O G G O C G G <br /> 0000000 <br />