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-Dave t 3 4q- -7 8 74 — -to PCC ple rmlt MC0711) <br /> Bur,.I rAt County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'V ci Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> N ti <br /> 4>I;L 329t, a <br /> OWNER G� Sr�t LO TELEPHONE g(o(o _ 9g, o <br /> HOME ADDRESS O <br /> c7 iV WO <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER R �I L/ ROAD NAME r ��55 U 20 1 ~ <br /> EFa <br /> LEGAL DESCRIPTION (see tax receipt) L a C6h) V l b P(' I CL k a(I-q&-7 m <br /> y m <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ m <br /> 0 <br /> TYPE OF PERMIT(S): v /y <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ,� 5 "2 <br /> , l m <br /> STRUCTURE/ADDITION USE: iS <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: TI GE Iir <br /> Ii <br /> M <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a d <br /> -n 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 <br /> NORTH(N). y G <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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 I <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 0 C <br /> MUST BE SIGNED AND DATED BY THE OWNER. ) o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> c 3 <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (1 ; i <br /> ISSUANCE. )n ` <br /> (J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �.1 J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY t O <br /> PERMITTED. -4) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> IN- <br /> SETBACK A, EA.5. <br /> zv � �� v�ov <br /> m . m <br /> 6. + <br /> 26'7121 �e �. � v m CL 0,a m <br /> ovyiqre66 <br /> Z CD <br /> 7. main d7 - 0 � _ P : m <br /> I declare that this application (inci"kdny accompanying schedule) has been examined by me and to the best of my G) c 10 <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that ICDrecognizeA <br /> Inn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <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 akAove described premises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> CD : <br /> SIGN HERE <br /> (signature of o nec b in c ctor) 7 (date) <br /> ZONING ADMINISTRATO ��`� Q: ` . ` ` ` to <br /> fn N+f»to to is <br /> r'� N NNNNN <br /> In <br /> (n O K) (n O O <br /> TO NSHIP PERMITS MAY BE REQUIRED �j� 0 0 0 0 0 0 0 <br />