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Burn c-A County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> U7 O <br /> 41 <br /> C ` <br /> OWNER �t7lph1t+ l W Y O`CJL� TELEPHONE 1 WAo <br /> O <br /> MAILING ADDRESS 13 $io 0 � Iy V� � �y,e�� � S��3 1 <br /> PROPERTYADDRESS ©ov�ral hV'. <br /> ,y / Q <br /> LEGAL DESCRIPTION(see tax receipt)` Cv `,8 CIMy J 17 P//S JR-��`��o p Com' <br /> 0 <br /> rr�� i <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE I/J� ADDITION 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> l+ N <br /> STRUCTURE/ADDITIONUSE: IUE� 43 �1tl 64~4 T V�J <br /> D(Home/Cabi , Commercial Business;Bedroom; Deck;etc.) Ll <br /> BUILDING CONTRACTOR: P\U_`jf$-, <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <br /> NORTH(N). 3 <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 \ o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. (W" <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. p N 10 <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. Q t <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> n <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o - 1 <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT —i Q <br /> ISSUANCE. 11 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE/R- <br /> ^SETB`ACK ARE,P. ;��/ I1,, _ . ) � //���1. I` ` i; /�/3cd W eilct d <br /> 5. / *l l�(� I U`7 ^�'elVnVyf I W J l/rf liv ( s uv l m w r >0 > 0 M <br /> 1 O\ �LQ C❑t ll�-� w��J �a $ 3 n `2° FaF. 3_ <br /> j V1 J m <br /> 6. .o m C N '^ 0 9 <br /> Z w (D 0 0 0 <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n !a � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- � <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 m <br /> providing in this appli tion. I a r e to permit county officials charged with administering county ordinances or other <br /> authorized person to a acc a above described premises at any reasonable time for the purpose of inspection. o <br /> SIGN HERE 66 o3 n <br /> (signature of e r building contracto (date) <br /> ZONING ADMINISTRATOR �"7 dl fAMM6940 69 N <br /> N OI N N O O <br /> CL <br /> f, NO (T (r00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />