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Burgett Cc-pnty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o o <br /> APPLICATION FOR LAND USE PERMITS CD 3 <br /> - r <br /> y O <br /> N <br /> �OWNER I p� / o�bekk �QXCI �-�e l�r{ TELEPHONE �I5- �po 1- rJ I04 <br /> HOME ADDRESS 2a �� OGbJ Lit FCe _ 0 <br /> it►L <br /> 0 m <br /> EMERGENCY/FIRE NUMBER a s lI ROAD NAME Li rf�Q 1000d f(p o <br /> S61//y 5'Q S/?38/918 w Acus S:yoo 1 <br /> LEGAL DESCRIPTION(see tax receipt) W ..' F <br /> _38 _ I g U-A 410 uu 33u• C' S •710' (rev L*+ S rn <br /> e <br /> o <br /> DWELLING/BUILDING 11 GARAGE/ACCESSORY STRUCTURE 1:1ADDITION )cPRPRIVY ❑ C-x S Su' Q <br /> TYPE OF PERMIT(S): c <br /> IT <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> ` .- <br /> STRUCTURE/ADDITION USE: 'w ` �OS�7c TaAyU 0 <br /> � ((( ` <br /> (Home/Cabin; Comimercial Busines ; Bedroom; Deck; etc.) rn <br /> � m <br /> BUILDING CONTRACTOR: \C V' LL YMp l <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n — <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m ;o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M f <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V <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. rN <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. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN -r <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <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 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WII,T,HIN, THE REQUIRED WATER <br /> SETB5. ACK AREA. <br /> �l h /��y�aLaV✓ C_Q 'yV � -U 0 g 0 C 0 <br /> rn <br /> 6.� `/O t/ffLJ/j ��J m � 3 a m �c <br /> U � 'O : N <br /> 7. Z ' `" '" Z <br /> o :O <br /> C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j c . p <br /> knowledge and belief it is true,correct and complete. Lacknowledge that I am responsible for the detail and accuracy of m 0 c <br /> n (D <br /> all information contained in this application(includin n m anying schedule)and I further declare that I recognizem m <br /> that this information I am providing will be relied upo Burnett Wisconsin in determining whether to is- t7 <br /> sue a permit. I further accept all liability which may f Burnett relying on this information I am m <br /> providing in this application. I agree to permit cou official it I Pring county ordinances or other m <br /> authorized person to have access tq,the above des d premises at a n '' or the purpose of inspection. T <br /> y CD <br /> m <br /> AK <br /> SIGN HE4Q11A116' Ant <br /> ( ure owner or buil / U (date) <br /> ZONING ADMINISTRATOR <br /> G ��uiN�uicn <br /> N N 01 N N O1 N <br /> 01 VI OOH MOP <br /> ZWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />