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6) <br /> Ett County 7410 CO. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> N <br /> L ( IC <br /> OWNER ��AI ''- K►��-�4 h.'eY�t 14N TELEPHONE n <br /> o <br /> r 1n //�� 11 <br /> HOME ADDRESS Jtgj S Vin4ariq � � McWdo4A �j - o <br /> EMERGENCY/FIRE NUMBER 3-a-7 ROAD NAME .�oo/v 4 � <br /> CQvo1,v-f- ,;) s-/ 7=0Yo kilSW J-o-+ 3 <br /> LEGAL DESCRIPTION(see tax receipt) I -, Hao I _ 0'j-- $DD m <br /> 0 <br /> El (n <br /> PRIVY ❑ rn v <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. fi <br /> (� <br /> eeti <br /> STRUCTURE/ADDITION USE: �j M 10, "t-63k1 t 59 92• se- Pte^ <br /> / j (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: nef9-A4464 ,&�1o1r1�15 I&C 10636 ILIiJI10A-A 0:j�w4td lir (� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN$1F,X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p = .0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 Q <br /> Z ql <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> Q -4 <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 (, <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF `J1 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 I �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> 0. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN -r S <br /> NEEDED. j <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. -fl <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p0 <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 /> SETBACK <br /> AREA. �y nC Y L 1 �^ q �1 /� <br /> i i rrca� (✓l lntw /V T T TV �Q'1 S-5. S/1 j qA bpN WN64uc.? � m i' a o -V <br /> I rn <br /> pr-6 Pa' SBC, L1�A/(/D) o� LArtiQube Dr�Q .-t -1- be lc&s td". LD. a �" y . <br /> m cm 3 <br /> C go _ P - / y� ,� -�-� o y5 <br /> m <br /> I declare that thi pplication (including any accompanying schedule) has been examined by me and to the best of my L7 c c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d <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 hayolaccess to theajoa des ibed premises at any reasonable time for the purpose of inspection. -n <br /> m <br /> CD <br /> SIGN HERE /494 4417&x� <br /> (signal o n of building contract �, (date) <br /> ZONING ADMINISTRATOR . . . . . . <br /> Q En wwE fn w� <br /> P UI" 04 <br /> TOW HIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0000000 <br />