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Burnett Codnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning AdministratoC o <br /> APPLICATION FOR LANQ USE PERMITS 3. <br /> n r Uri u)s s' � a N ° . <br /> OWNER jjgjRr Ff• �7 �/nP�tRScs/✓ LEPHONEtk <br /> HOME ADDRESSRZe'e Vo <br /> r � <br /> EMERGENCY/FIRE NUMBER [S ROAD NAME ) <br /> '5 <br /> LEGAL DESCRIPTION (see tax receipt) lmoo 4,„7- y �� V 45 3 p" SS' y <br /> CD <br /> a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY0 <br /> ❑ (� <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING/ El <br /> CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: /y/.F tib /�o'47f` v- , R o_ <br /> 94 (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) c <br /> BUILDING CONTRACTOR: A&CLWAIUP L}tl/L/�EQSy ..>aie 24AIRUR <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n B <br /> �I 5 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v <br /> n m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 B <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. 1 0 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> v � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z vY ` ) <br /> CONDITIONS OF PERMIT: o w' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N <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. v i <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> B. v� W--� 1. m 3 CL m a(D <br /> mCN :^ o � 3 <br /> 7. Z : v, ma <br /> o T C : m <br /> - �: A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C <br /> that this information 1 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 application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the ab ve described premises at any reasonable time for the purpose of inspection. m <br /> -nCD <br /> i <br /> CD <br /> SIGN HERE <br /> (sig ur f gwner or builg c tractor) (date) <br /> ZONING ADMINISTRATOR <br /> OWNSHIP PERMITS MAY BE REQUIRED LPA '1 <br />