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Bu lett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> OWNER (CJk arh b E/--k 2.c-t4z3-V\ µJS}f CID-V-50&J TELEPHONE n p1 <br /> giora BRiaL <br /> Q waY + <br /> HOME ADDRESS �6� t,�y Wt Z��3 N,f')'1vCIII4tU �t7.I<Q P.tt TOk%Nr+ DgNL2 <br /> [�,�j 1 1 r <br /> EMERGENCY/FIRE NUMBER -1 b S 3 ROAD NAMENO MUS` yv �Wk k`1 0 <br /> LEGAL DESCRIPTION(see tax receipt) t�j <br /> G L &-o V �-p-(- 1 - 0 -7 -6 04c, n`0 O I&op <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE 1:1ADDITION 1:1PRIVY ❑ n` <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ) n <br /> � b , n/ N <br /> STRUCTURE/ADDITION USE: GC, L 1 <br /> //�� <br /> (Home/Cabin; m <br /> pCommercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: Aao ( P H- f (C-K l`Q it <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. D r T <br /> Sfk �0�f �a ( � rk Stcr� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) rl ,� SIS"' �S O n <br /> n <br /> -n 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 m CD <br /> NORTH(N). W 3 <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. a <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 1 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN `» S <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 I <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/WITHIN THE REQUIRED WATER <br /> AETBACK AREA. <br /> � (S <br /> AtP/h[aN�o HCl v4� Tu r ncc� G�OkK".�,(/�Gb l✓i <br /> 5._ <br /> ^ U A O D O 0.D O V <br /> 6. ��/l�G2G� S'hIQ��E7� Cc� Slg'/�+L Ccf/d 0 , 3 n 2 x n m <br /> ,[ / p�i' J /� � �/' r / o <br /> �. - 1 e�liS/1��i�Ulw hl ' '�S r i�e.4--`�y� i i'u.. Lj G�Q X75/ P ' y m <br /> I declare that this application (includi any accompanying schedule) has been examined by me and to the best of my G) O <br /> o c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a ,.. A <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` <br /> PP ( 9 Y ) 9 ° m p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- n <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am rJ m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> co <br /> authorized persgtqo have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> gla � lo <br /> SIGN HERE <br /> ign ure of own r wilding contractor) (date) pp �� <br /> ZONING ADMINISTRATOR . . l` <br /> TOWNSHIP PE MITS MAY BE REQUIRED lJ <br />