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I#urnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> C <br /> CD ` <br /> OWNER n0�/�`u/d/7 TELEPHONE Ire y2aa \ <br /> HOME ADDRESS `otl� (fJ�IO Yy� (r� 1CD <br /> �� v <br /> o <br /> EMERGENCY/FIRE NUMBER f a�63� ROAD NAME /�%� <br /> rte'=�c-er' � i. {� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> R <br /> 513 Tq0 RIs vo/a CR <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LTJ PRIVY ❑ �� �� 'D rn 0 <br /> 0 <br /> TYPE OF PERMIT(S): o ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> I / N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabi�r;Commercial Business; Bedroom;Deck;etc.) vi <br /> / m <br /> BUILDING CONTRACTOR: dc„4- GsiA j1_ 6{ <br /> c � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Z 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 r� <br /> NORTH(N). CA \ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In \ 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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N n <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1C1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr S <br /> NEEDED. a rr,,11 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> lJ� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ✓�2. REMOVAL REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPE CAVY <br /> PERMITTED. <br /> J` I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WIT E REQ U R <br /> SETBACK AREA. <br /> 1� ,� <br /> 5. ^ fa, tesf,es/tom -&o be Cck; 0 d <br /> A170rn 0� 0 .0 <br /> D '' ° m <br /> 6. c3 <br /> GAm <br /> ,�lsl i /� ^ Z : <br /> 7. J> o <br /> 0)i Im m <br /> I declare that this application (including any accompanying schedule) has been exams nd to est of my C' C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible ile accuracy of E ? o ': <br /> all information contained in this application(including an accompanyingschedule and I furt at I recognize m m <br /> PP ( 9 Y ) 9 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in de i rig whether to is- v d <br /> sue a permit. I further accept all liability which maybe a result of the County of Burnett relying on t . information I am UJ E m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have acces to the 9bove described premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> CD <br /> q/� <br /> SIGN HERE ?WA <br /> (signs re of owner or bullolpg contractor) (date) <br /> ZONING ADMINISTRATOR . . . . . . d+ <br /> " 4041kw'A4� <br /> N NN N Nino <br /> N pp1 nfn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />